east Foundation
The EAST Foundation was officially incorporated in 2002 for the purpose of providing the Eastern Association for the Surgery of Trauma the capability to fully achieve its objective of supporting and promoting the key missions of EAST, including the care, investigation, and prevention of injury, trauma education, and encouraging the development of the young trauma practitioner and investigator. This will be accomplished by raising funds and managing their growth through prudent investment, without the restrictions imposed upon EAST as a nonprofit corporation. EAST is the sole member of the EAST Foundation, EASTERN ASSOCIATION FOR THE SURGERY OF TRAUMA Inc., and has the authority to appoint the Foundation Board of Directors, and thus assure that its vision continues in the right direction, but the Foundation is otherwise free of any direction or control by EAST over its activities. January 13-17, 2009 The EAST Foundation seeks your support as an EAST member to fulfill its mission: Disney Yacht & Beach Club Resort Assuring the future for the care, investigation, and prevention of injury. As our financial resources grow, we envision several projects to support this mission. Already, the EAST Orlando, FL Foundation is managing the funds for the Scott B. Frame Memorial Lecture, the Raymond H. Alexander Resident Paper Competition, the John M. Templeton, Jr. MD Injury Prevention Paper Competition, and the Wyeth Scholarship. Other plans for the future include such ideas as a conference for trauma nurses and fellows, funding of liaisons with other organizations involved in trauma care, expanding lectureships by major figures at the annual EAST meeting, and support of public advocacy and legislation on behalf of victims of injury. Fundraising has already been quite successful from the EAST membership. The Board of Directors of both EAST and the EAST Foundation have pledged their full commitment by contributing to the Foundation, to demonstrate to you, the EAST members, the utmost importance they attach to this endeavor. Please consider a yearly tax-deductible contribution to this worthy cause. You, your colleagues, and your profession are the direct beneficiaries. The Board of Directors of the EAST Foundation is available to you for any questions or suggestions you may have and are grateful for your generosity. Twenty-Sixth Sincerely,
The Board of Trustees, EAST Foundation TWENTY SECOND ANNUAL SCIENTIFIC ASSEMBLY
This activity is jointly sponsored by Wake Forest University School of Annual ScientificMedicine and the Eastern Association for Assembly
theJanuary Surgery of Trauma 15-19, 2013
JW Marriott Camelback Inn Scottsdale, Arizona
This activity is jointly sponsored by Wake Forest School of Medicine and the Eastern Association for the Surgery of Trauma General Information
Welcome to Scottsdale and the 26th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma (EAST). The Program Committee, chaired by EAST Recorder Stan Kurek, and the Careers in Trauma Committee, led by Nicole Stassen, has developed an outstanding program of scientific sessions, sunrise sessions, and workshops. Join your colleagues and friends and catch up at the Opening Reception and the annual barbecue that will take place in the resort’s own Wild West town, Mummy Mountain (weather permitting). While we had to replace the annual Dodge Ball Tournament with a competition event that features laser tag, we expect the institutional rivalries between teams to remain lively. As you can see, we have planned an exciting week of education and recreation, with plenty of time for networking!
As is customary, our Scientific Sessions will start off with the Raymond H. Alexander, MD Resident Paper Competition, and the EAST Foundation will again support the Cox-Templeton Injury Prevention Paper Competition. This year’s Scott B. Frame lecturer will be one of EAST’s founding members, Norman E. McSwain, Jr., who was one of Dr. Frame’s mentors. His presentation will focus on the history of the PreHospital Trauma Life Support course. C. William Schwab, a past EAST President, will serve as our 4th Oriens Award Keynote Speaker.
For a number of years, EAST has collaborated with the Society of Trauma Nurses (STN) to develop a series of sunrise sessions and one parallel plenary session. In addition to STN, EAST also welcomes participation by the Pediatric Trauma Society in the Annual Scientific Assembly. I offer my gratitude to the members and Chairs of EAST’s Committees for their efforts in conceiving the wide array of topics and organizing the plenary and sunrise sessions, as well as the workshops. We believe this year’s agenda is both full and engaging. The educational offerings truly provide “something for everyone” and stand ready for your participation.
I also recognize the significant contributions made to the EAST Foundation by the its President, Fred Luchette, and its Board of Trustees, all supported by the Foundation’s Executive Director, Pamela Bowerman. Their ongoing fundraising continues to grow the Foundation corpus, as well as support many of EAST’s scholarly activities. I am grateful to all EAST members who have contributed to our Foundation.
While the meeting is jam-packed, I hope you will find some time to spend with your family enjoying the many recreation activities offered by this beautiful venue. As you get out and explore the many features found in the Phoenix metropolitan area, I’m confident you will enjoy your visit to the Valley of the Sun!
Finally, I thank you, the members of EAST, for trusting me to lead your organization over the last year. I am gratified by EAST’s continued growth and am proud to boast that it now has the largest membership of any trauma society in the US. EAST has achieved its many successes because of the hard work of its members, and I thank those who have contributed over the past year. Our Committees and Ad Hoc Committees are always looking for new ideas and welcome those who eagerly volunteer both their time and talents. I am deeply humbled to have been elected to lead this great organization and thank you for this opportunity. Enjoy the meeting!
Best wishes,
Jeffrey P. Salomone, MD, FACS, NREMT-P President, Eastern Association for the Surgery of Trauma
EAST Mission Statement
EAST is a scientific organization providing leadership and development for young surgeons active in the care of the injured patient through interdisciplinary collaboration, scholarship, and fellowship.
EAST Vision Statement
EAST seeks to improve care of the injured by providing a forum for the exchange of knowledge in the practice of trauma surgery; to promote trauma prevention, research, and improved trauma systems design; to encourage investigation and teaching of the methods of preventing and treating trauma; and to stimulate future generations of surgeons to meet the challenge.
Future Meetings
January 14-18, 2014 Naples Grande Beach Resort Naples, Florida
January 13-17, 2015 Disney’s Contemporary Resort Lake Buena Vista, Florida
January 12-16, 2016 JW Marriott San Antonio San Antonio, Texas
January 10-14, 2017 Diplomat Resort Hollywood, Florida
January 9-13, 2018 Location to be Determined
OFFICE OF CONTINUING MEDICAL EDUCATION
LEARNER BILL OF RIGHTS
Wake Forest School of Medicine (WFSM) recognizes you are a lifelong learner who has chosen to engage in continuing medical education (CME) to identify or fill a gap in knowledge, skill, or performance. As part of WFSM’s duty to you as a learner, you have the right that your CME experience with us includes:
• Content that: o Promotes improvements or quality of health care; o Is valid, reliable, and accurate; o Offers balanced presentations that are free of commercial bias for or against a product/service; o Is vetted through a process that resolves any conflicts of interest of planners, teachers, or authors; o Is driven and based on learning need, not commercial interests; o Addresses the stated objectives or purpose; and o Is evaluated for its effectiveness in meeting the identified educational needs.
• A learning environment that: o Supports learners’ ability to meet their individual needs; o Respects and attends to any special needs of learners; o Respects the diversity of groups of learners; and o Is free of promotional, commercial, and/or sales activities.
• Disclosure of: o Relevant, financial relationships planners, teachers, and authors have with commercial interests related to the content of the activity; and o Commercial support (funding or in-kind resources) of the activity. Eastern Association for the Surgery of Trauma 26th Annual Scientific Assembly
Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Wake Forest School of Medicine and the Eastern Association for the Surgery of Trauma. The Wake Forest School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
CME/CE Credit & Certificates
The Wake Forest School of Medicine designates this live activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (This maximum total includes all scientific sessions, plenary sessions, poster walk rounds, special lectures, and one sunrise session each of the days they are offered.)
The Society of Trauma Nurses (STN) has applied to the Georgia Nurses Association to provide continuing education for the STN-developed programming. A total of 4.5 educational contact hours are being submitted for approval.
This activity is acceptable for 2.0 CEU’s.
Within five business days following the conference, you will receive an e-mail from Ms. Andrea Smalt, Registrar for the Office of Continuing Medical Education at Wake Forest School of Medicine. The email, which will contain the name of the conference in the subject line, includes a web-based link to an online evaluation form. After completing the evaluation, you will be asked to verify your participation and what type(s) of continuing education credit you need. After verification, you will have the option to print a certificate for your records. You will have two weeks from the receipt of the e-mail to complete the evaluation and print a certificate.
ABS MOC Part 2 – CME & Self-Assessment Eligibility
As of July 1, 2012, the American Board of Surgery (ABS) requires that 60 of the 90 AMA PRA Category 1 Credit(s)TM completed over a three-year Maintenance of Certification (MOC) cycle include a self-assessment activity. Self-assessment is a written or electronic question and answer exercise that assesses a surgeon’s understanding of the material presented. The 26th Annual Scientific Assembly will feature a number of educational sessions that will offer AMA PRA Category 1 Credit(s)TM and self-assessment credits toward Part 2 of the ABS MOC Program. A post-test for the designated sessions will be conducted, and a minimum score of 75% must be achieved to receive credit.
Documentation of Attendance
Please be sure to sign-in each day to document your attendance at the general sessions. Separate sign-in sheets will be available at the workshops/courses, poster walk rounds, and sunrise sessions.
Learner Objectives
At the conclusion of this activity, the learner should be better able to: Examine and implement injury prevention techniques which may lessen the burden of injury. Articulate methods to optimize outcomes for the injured patient in austere/military environments. Develop leadership skills to enhance his/her ability to work within a multidisciplinary team. Foster a multidisciplinary approach to the care of the injured patient. Interpret the presentation of scientific research in the treatment of the injured patient. Evaluate and implement the organization and management of an institution’s trauma system of care, including the appropriate use of advanced practitioners as part of the trauma team.
Planning Committee, Faculty, & Staff Disclosures
As an accredited CME provider, Wake Forest School of Medicine requires that everyone comply with the 2004 Updated Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. All EAST Board of Directors members, Program Committee members, additional planning committee members, speakers/presenters, and staff have been asked to disclose any significant financial interest or relationship they may have with the manufacturer(s) of any commercial product/service. Their responses are listed below. The ACCME Standards require that all presentations be free of commercial bias and any information regarding commercial products or services be based on scientific methods generally accepted by the medical community. When discussing therapeutic options, speakers have been asked to use only generic names. If it is necessary to use a trade name, then those of several companies are to be used. Further, should presentations include discussion of any unlabeled/investigational use of a commercial product, speakers are required to disclose that information to the audience.
In the spirit of full disclosure, the following information is provided to all attendees: Alex Busko has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Britton Christmas serves as a consultant to Cook Medical and CR Bard in physician training on vena cava filters. Dr. Bryan Cotton has grant/research support from Haemonetics Corporation for an investigator-initiated multicenter study of TEG in severely injured patients. Dr. Emiliano Curia has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Yanbin Dong has research/grant research from the National Institutes of Health (NIH). Dr. Therese Duane is on the speaker’s bureau for and serves as a consultant to Pfizer. Dr. Juan Duchesne serves as a consultant to Pfizer. Dr. Gerardo Guarch has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Scott Gunn serves as a consultant to ICU Medical. Dr. Adil Haider has grant/research support from the National Institutes of Health (NIH)/National Institute of General Medical Sciences (NIGMS). Dr. Elliott Haut has grant/research support from the Agency for Healthcare Research and Quality (AHRQ) and receives book royalties from Lippincott, Williams, and Wilkins. Dr. Michael Hawkins has grant/research support from the National Institutes of Health (NIH). Dr. Thomas Hayward is on the speaker’s bureau for Baxter. Dr. Sanjeeva Kalva has grant/research support from the National Institutes of Health (NIH) and receives royalties for book chapters from Amirsys Corporation. Dr. John Mayberry has grant/research support from and is a consultant to Acute Innovations. Dr. Regina Medeiros has grant/research from the National Institutes of Health (NIH). Dr. Avery Nathans serves as a consultant to the American College of Surgeons’ Trauma Quality Improvement Program (Director). Dr. Elizabeth NeSmith has grant/research support from the National Institutes of Health (NIH). Dr. Keith O’Malley has grant/research support from the National Institutes of Health (NIH). Dr. Herb Phelan has grant/research support from the National Institutes of Health (NIH). Dr. Kenneth Proctor has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Jeff Salomone serves as the Editor to Prehospital Trauma Life Support but receives no royalties. Dr. Chris Schwartz is a stock shareholder with GlaxoSmithKline. Dr. Adam Shiroff serves as a consultant to and is on the speaker’s bureau for Synthes. Dr. Chad Thorson has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Robert Van Haren has grant/research support from the Office of Naval Research and the US Army Medical Research and Material Command. Dr. Donald Yealy has grant/research support from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of General Medical Sciences (NIGMS). Haidong Zhu has grant/research support from the National Institutes of Health (NIH).
No one else had anything to disclose. Printed December 17, 2012. Any additional disclosures received after this date will be announced.
Commercial Support
EDUCATIONAL GRANTS Educational grants have been provided by the following:
Acute Innovations to help pay for expenses associated with the Techniques of Rib Fracture Plating in Unstable Chest Wall Injuries Workshop on Saturday, January 19
Synthes USA Products, LLC to help pay for expenses associated with the Techniques of Rib Fracture Plating in Unstable Chest Wall Injuries Workshop on Saturday, January 19 and to help pay for expenses associated with the Raymond H. Alexander, MD Resident Paper Competition of the EAST Foundation
Z-Medica to help pay for expenses associated with the Leadership Development Workshop: Part I on Tuesday, January 15 and to allow up to 10 fellows to attend the 26th Annual Scientific Assembly, which will be used to pay their conference registration fees and associated travel expenses
IN-KIND SUPPORT In-kind donations, equipment loans, supplies, materials, etc. have been provided by the following:
Acute Innovations training kits and related supplies for use at the Techniques of Rib Fracture Plating in Unstable Chest Wall Injuries Workshop on Saturday, January 19
SonoSite, Inc. loan of 10 ultrasound systems for use at the Ultrasound for the Acute Care Surgery Service Workshop on Saturday, January 19
Synthes USA Products, LLC medical equipment and related supplies for use at the Techniques of Rib Fracture Plating in Unstable Chest Wall Injuries Workshop on Saturday, January 19
EXHIBITORS (as of December 17, 2012) Acute Innovations Aspen Medical Products Borgess Health Daxor Corporation EAST Foundation EmCare Acute Care Surgery Ethicon Geisinger Health System Haemonetics Corporation Hospital Corporation of America (HCA) Hutchinson Technology, Inc. ImaCor, Inc. Össur Americas Pediatric Trauma Society Pikeville Medical Center, Inc. Sharp Medical Products, LLC Society of Trauma Nurses StarSurgical, Inc. Stonebridge & Company Synthes CMF TEM Systems, Inc. (formerly ROTEM) Trauma Center Association of America Vidacare Corporation Z-Medica Corporation
Further Information & Questions
For post conference-specific or CME/CE questions/requests, please contact:
Office of Continuing Medical Education Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC 27157-1028 Direct: 336-713-7755 or Toll-Free: 1-800-277-7654 Fax: 336-713-7701 E-mail: [email protected] www.wakehealth.edu/cme
For EAST business/membership questions/requests, please contact:
Ms. Christine Eme, CAE, CMP, Executive Director Eastern Association for the Surgery of Trauma 633 N. Saint Clair Street, Suite 2600 Chicago, IL 60611 Direct: 312-202-5498 Main: 312-202-5508 Fax: 312-202-5064 E-mail: [email protected] www.east.org
Overall schedule
Eastern Association for the Surgery of Trauma (EAST) 26th Annual Scientific Assembly in collaboration with Society of Trauma Nurses (STN) Pediatric Trauma Society (PTS)
OVERALL SCHEDULE
TUESDAY, JANUARY 15, 2013 6:45am-7:00pm Registration North & South Registration – CC 8:00am-5:00pm Speaker Preparation Room Palo Verde
Workshops – Additional fees apply. Pre-registration required. 7:00am-4:30pm Trauma Outcomes Performance Improvement Course (TOPIC) Arizona C/D – CC Presented by the Society of Trauma Nurses
1:00pm-4:00pm Acute Care Surgery Workshop Arizona E Presented by the EAST Acute Care Surgery Ad Hoc Committee
1:00pm-5:00pm Practical Considerations in Trauma Outcomes Research Sunshine Presented by the EAST Research Ad Hoc Committee
1:00pm-6:00pm Leadership Development Workshop: Part I Arizona A/B – CC Presented by the EAST Careers in Trauma Committee
Other EAST Events & Meetings 6:45am-3:00pm EAST Community Outreach Thunderbird Christian Academy 6:45am-7:15am – Volunteer Breakfast – Arizona Foyer Scottsdale, AZ 7:15am – Board Bus – JW Marriott Camelback Main Entrance 7:30am – Bus Departs
12:00pm-4:00pm Publications Committee Meeting Cottonwood Room
12:00pm-5:00pm Exhibit Set-up Arizona Ballroom F/H/M – CC
2:00pm-4:00pm EAST Foundation Board of Trustees Meeting Boardroom
4:00pm-9:00pm EAST Board of Directors Meeting Town Hall
WEDNESDAY, JANUARY 16, 2013 6:00am-6:00pm Registration & CME Sign In North & South Registration – CC 6:00am-5:00pm Speaker Preparation Room Palo Verde
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
Sunrise Sessions 1-5 – These are ticketed sessions. Pre-registration required. 7:00am-7:50am SS 1 – Transfusion Medicine 2012 and the Military Arizona A/B – CC 7:00am-7:50am SS 2 – Peptic Ulcer Disease: Updates in Management Arizona C/D – CC 7:00am-7:50am SS 3 – Pediatric Massive Transfusion Protocols Arizona E – CC 7:00am-7:50am SS 4 – Successful Billing and Coding for Advanced Practitioners South Peach Pipe 7:00am-7:50am SS 5 – Recognizing & Caring for the Victim of Domestic Violence North Peace Pipe
7:30am-9:00am Continental Breakfast Arizona F/H/M – CC
8:00am-5:00pm Exhibits Arizona F/H/M – CC
8:00am-8:45am Opening Remarks & Flag Presentation Arizona G/I/J/K/L – CC
8:50am-10:30am Scientific Session I: Raymond H. Alexander, MD Resident Paper Arizona G/I/J/K/L – CC Competition of the EAST Foundation
10:30am-10:50am Break – Refreshments Provided in the Exhibit Hall Arizona F/H/M – CC
10:50am-12:30pm Scientific Session II: Raymond H. Alexander, MD Resident Paper Arizona G/I/J/K/L – CC Competition of the EAST Foundation
12:30pm-1:30pm EAST Marketplace Lunch – Lunch Provided in the Exhibit Hall Arizona F/H/M – CC
Committee Meetings 12:30pm-1:30pm Advanced Practitioners Ad Hoc Committee Arizona A/B – CC 12:30pm-1:30pm Bylaws Committee Boardroom 12:30pm-1:30pm Careers in Trauma Committee Arizona C/D – CC 12:30pm-1:30pm Injury Control & Violence Prevention Committee North Peace Pipe 12:30pm-1:30pm Membership Committee Arizona E – CC 12:30pm-1:30pm Pediatric Trauma Ad Hoc Committee South Peace Pipe 12:30pm-1:30pm Seniors Committee Cottonwood A/B 12:30pm-1:30pm Research Ad Hoc Committee Cholla 12:30pm-1:30pm Scholarship Committee Town Hall
1:30pm-2:30pm Old Dogs vs. Young Bucks Arizona G/I/J/K/L – CC Presented by the EAST Acute Care Surgery Ad Hoc Committee
2:30pm-4:00pm EAST Annual Business Meeting – Open to EAST Members Arizona G/I/J/K/L – CC
4:00pm-5:30pm Scientific Papers That Should Have Changed Your Practice: Arizona G/I/J/K/L – CC Part III Presented by the EAST Program Committee
4:00pm-5:30pm Advocacy 2013: Getting In, Staying Involved, and Being Prepared Arizona A/B – CC in the Post-Affordable Care Act Era Presented by the EAST Advocacy & Outreach Ad Hoc Committee
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
4:00pm-5:30pm The Burden of Urban Youth Violence: A Plea for Prevention Arizona C/D – CC Presented by the Society of Trauma Nurses
EAST Receptions & Special Events 5:45pm-6:45pm EAST Foundation Donor Appreciation Reception (by invitation) North Peace Pipe
5:45pm-6:45pm Exhibitor Welcome Reception Town Hall
6:30pm-8:30pm Opening Reception – Ticketed Event – RSVP Required Sonoran Terrace – CC
8:30pm-9:30pm New Member Reception – Members Elected January 2012 Town Hall (by invitation)
THURSDAY, JANUARY 17, 2013 6:00am-6:00pm Registration & CME Sign-in North & South Registration – CC 6:00am-5:00pm Speaker Preparation Room Palo Verde
Sunrise Sessions 6-10 – Ticketed sessions. Pre-registration required. 7:00am-7:50am SS 6 – 2012 – The Year In Combat Arizona A/B – CC 7:00am-7:50am SS 7 – Billing and Coding the Complex Acute Care Surgical Cases Arizona C/D – CC 7:00am-7:50am SS 8 – Pediatric Trauma Jeopardy Arizona E – CC 7:00am-7:50am SS 9 – How to Create, Understand, and Use PMGs South Peach Pipe 7:00am-7:50am SS 10 – Medications and Trauma: How Do You Combine Them North Peace Pipe to Make Them Work?
7:30am-9:00am Continental Breakfast Arizona F/H/M – CC
8:00am-1:00pm Exhibits Arizona F/H/M – CC
8:00am-9:40am Scientific Posters Set-up – All Posters to be Set by 3:00pm West Foyer – CC
8:00am-9:40am Scientific Session III-A: Clinical Trauma Surgery Arizona G/I/J/K/L – CC 8:00am-9:40am Scientific Session III-B: Cox-Templeton Injury Prevention Sunshine Paper Competition of the EAST Foundation
9:40am-10:00am Break – Refreshments Provided in the Exhibit Hall Arizona F/H/M – CC Special Announcements and Raffle
10:00am-11:00am Scott B. Frame, MD Memorial Lecture of the EAST Foundation Arizona G/I/J/K/L – CC Norman E. McSwain, Jr., MD, FACS, NREMT-P
11:00am-12:00pm Teach and Learn/Learn and Teach: Mentorship and Your Arizona G/I/J/K/L – CC Professional Development Presented by the EAST Research Ad Hoc Committee
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
12:00pm-1:00pm Lunch on Your Own
Committee Meetings 12:00pm-1:00pm Advocacy & Outreach Ad Hoc Committee Arizona E – CC 12:00pm-1:00pm Acute Care Surgery Ad Hoc Committee North Peace Pipe 12:00pm-1:00pm Information Management & Technology Committee South Peace Pipe 12:00pm-1:00pm Military Ad Hoc Committee Arizona A/B – CC 12:00pm-1:00pm Practice Management Guidelines Ad Hoc Committee Cholla 12:00pm-1:00pm Program Committee Arizona C/D – CC 12:00pm-1:00pm Rural Trauma Ad Hoc Committee Cottonwood 12:00pm-1:00pm Online Education Ad Hoc Committee Boardroom
1:00pm-2:00pm EAST Annual Oriens Presentation Town Hall 1:00pm – Keynote Address: C. William Schwab, MD, FACS 1:45pm-2:00pm – Oriens Essay Presentation: Charity H. Evans, MD
2:00pm-5:00pm EAST Practice Management Guidelines Plenary Session Arizona G/I/J/K/L – CC
3:00pm-5:00pm View Scientific Posters West Foyer – CC
Workshops & Courses – Additional fees apply. Pre-registration required. 1:30pm-5:45pm Delivery of Surgical Care in Resource Poor Settings Sunshine Presented by the EAST Careers in Trauma Committee
1:30pm-6:00pm Advanced Practitioners in Trauma Workshop Arizona A/B – CC Presented by the EAST Advanced Practitioners Ad Hoc Committee
2:00pm-4:30pm EAST Masters Course: This is How I Do It: Part IV Arizona C/D – CC Presented by the EAST Careers in Trauma Committee
EAST Receptions & Special Events 5:00pm-6:30pm Society of Trauma Nurses Networking Reception (by invitation) Town Hall
6:00pm-10:00pm Kids Klub Party – Pre-Registration Required Peace Pipe
6:30pm-10:00pm EAST President’s Reception & Dinner (by invitation) Lakeview Inn at the Camelback Golf Club 6:15pm – Bus Departs – JW Marriott Camelback Main Entrance
FRIDAY, JANUARY 18, 2013 6:00am-1:30pm Registration & CME Sign-in North & South Registration – CC 6:00am-11:30am Speaker Preparation Room Palo Verde
Sunrise Sessions 11-15 – Ticketed sessions. Pre-registration required. 7:00am-7:50am SS 11 – Before and After…Civilian Adaptation from Military Arizona A/B – CC Experience
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
7:00am-7:50am SS 12 – In an ERA of Damage Control Resuscitation, When Is Arizona C/D – CC the Best Time to Close the Abdomen? 7:00am-7:50am SS 13 – Special Issues in Pediatric Trauma Arizona E – CC 7:00am-7:50am SS 14 – Distracted Driving: How Do We Wreck This Deadly Habit? South Peach Pipe 7:00am-7:50am SS 15 – Practical Collaborative Trauma Research North Peace Pipe
7:30am-9:00am Continental Breakfast Provided in the Exhibit Hall Arizona F/H/M – CC
8:00am-12:00pm View Scientific Posters West Foyer – CC
8:00am-12:00pm Exhibits Arizona F/H/M – CC
8:00am-10:00am Scientific Session IV-A: Basic Science, Education, and Arizona G/I/J/K/L – CC Performance Improvement
8:00am-10:00am Scientific Session IV-B: Trauma Systems Sunshine
10:00am-11:00am Presidential Address Arizona G/I/J/K/L – CC The One Who Applies the First Dressing Jeffrey P. Salomone, MD, FACS, NREMT-P
11:00am-11:15am Gavel Exchange Arizona G/I/J/K/L – CC
11:15am-11:30am Special Presentations Arizona G/I/J/K/L – CC Introducing the EAST Trauma Bay – Social Media for EAST Members – Bruce Crookes, MD Updates in ACS: Re-evaluating Our Perceptions 10 Years Later – Matthew Lissauer, MD
11:30am-12:00pm EAST & EAST Foundation Awards Ceremony Arizona G/I/J/K/L – CC Raymond H. Alexander, MD Resident Paper Competition of the EAST Foundation Best Manuscript Award EAST Oriens Award John P. Pryor, MD Distinguished Service in Military Casualty Care Award Cox-Templeton Injury Prevention Paper Award of the EAST Foundation John M. Templeton, Jr., MD Injury Prevention Research Scholarship of the EAST Foundation Trauma Research Scholarship of the EAST Foundation 2012 Brandeis Scholarship Recipient of the EAST Foundation 2013 Society of Trauma Nurses/EAST Foundation Nurse Fellow Recipient 2013 Leadership Development Workshop Scholars Recognition
12:00pm-1:30pm Scientific Poster Walk Rounds West Foyer – CC
1:30pm-5:00pm Annual EAST Foundation Team Competition – Laser Tag Pitch and Putt (Front of Hotel)
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
6:30pm-8:30pm Family Reception/Barbeque – Ticketed Event – RSVP Required Mummy Mountain Weather Backup: Sunshine/Cholla
SATURDAY, JANUARY 19, 2013 7:00am-12:30pm Registration North & South Registration – CC
8:00am-10:30am EAST Board of Directors Meeting Town Hall
EAST Post-Meeting Workshops – Additional fees apply. Pre-registration required. 8:00am-12:00pm Techniques of Rib Fracture Plating (RFP) in Unstable Chest Cholla Wall Injuries 10:30am-12:00pm – Breakout 1 – North Peace Pipe 10:30am-12:00pm – Breakout 2 – South Peace Pipe
7:30am-3:30pm Ultrasound for the Acute Care Surgery Service Banner Simulation Medical Center 7:30am – Breakfast – JW Marriott Camelback – Arizona Foyer Mesa, Arizona 8:15am – Board Bus – JW Marriott Camelback Main Entrance 8:30am – Bus Departs 9:00am – Workshop Begins This workshop will be conducted at the Banner Simulation Medical Center, 525 W Brown Road, Mesa, Arizona. Estimated one-way travel time is 30 minutes. Transportation to/from the JW Marriott Camelback Inn to Banner Simulation Medical Center will be provided by EAST.
Meeting Rooms Located in the Convention Center and Surrounding Meeting Rooms Refer to Resort Map for Exact Locations Rooms in the Convention Center indicated by “CC”
Mummy Mountain The Spa Western Town at Camelback Inn Sprouts
MUMMY MOUNTAINTRAIL
KIVA LANE
KIVA LANE
Jackrabbit Pool
Guest Laundry
Garden Lawn MARRIOTT ROAD
Rita’s Garden Terrace
R Bar OAD CIRCLE DRIVE BLT Lobby Tennis Pavillion Steak
MARRIOTT R Town Hall Peace Pipe
Bell Stand Cholla & Sunshine Sonoran Manor House Terrace Putting Green
Arizona Ballroom DESERT F
Playground AIRWAYS DRIVE SOUTH COURT
CIRCLE DRIVEPitch and Putt
LINCOLN DRIVE Stop Sign
22191 Camelback Inn Map.indd 1 10/8/10 1:21:53 PM BLT Steak As the name Bistro Laurent Tourondel suggests, Chef Tourondel presents his adaptation of the Modern American Steakhouse, elevating it with his signature style and finesse. BLT Steak integrates traditional elements of a cozy French Bistro with those of a stylish, urban environment. Unwind in the bar, in the intimate dining room, or in the outdoor courtyard with spectacular sunset views of Camelback Mountain.
Rita’s Kitchen A casual, contemporary Southwestern flair reigns throughout Rita’s Kitchen. The menu features home-style regional cuisine featuring favorites from north and south of the border, using locally grown, seasonal and fresh ingredients. Enjoy an authentic adobe setting or patio dining in the shade of a sprawling Ironwood tree.
R Bar R Bar features a variety of hand-crafted cocktails, house-made infusions and the Inn’s signature margaritas. A full menu of appetizers, small plates, and full entrees perfectly compliment this high energy lounge and patio. Located in the Southwestern inspired Lodge, the R Bar is the perfect place for meeting new people or gathering with old friends.
Sprouts A tranquil retreat featuring a sophisticated and nutritious menu without sacrific- ing flavor. Scottsdale’s only true Spa restaurant offers breakfast specialties, fresh salads, innovative sandwiches, small plates, organic beer and cocktails, an ex- traordinary wine selection along with fresh juices and smoothies.
Hoppin’ Jack’s No shoes, no shirt…no problem! Soak up some sun and enjoy hand-made pizzas, healthy and fresh salads and a variety of hot and cold specialty sand- wiches and burgers – all just a few barefoot steps away from the pool. Top it all off with a sweet treat from our selection of Ice Cream Creations.
Golf Grill Located at our expansive Camelback Golf Club, the Golf Grill is a great place to enjoy lunch, cocktails or Sunday brunch. Featuring views of the course and popular American fare. Don’t forget to take advantage of our complimentary shuttle service to the Golf Club.
Starbucks Whether you need an early morning espresso to energize, or an afternoon green tea to cool down, your favorite specialty beverages are made to order by Starbucks’ friendly baristas. Relax with a light snack on the outdoor patio, stay in touch with wireless internet or sink into a cozy overstuffed chair inside.
In-Room Dining Breakfast in bed. Late night snacks and champagne. No need to get dressed. If you would like something that’s not on the menu, let us know. A party for friends or associates? We’ll design the perfect event. In short, we’ll make every effort to fulfill your every request.
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For dining reservations or more information please press “At Your Service” on your phone and we will be happy to assist you.
22191 Camelback Inn Map.indd 2 10/8/10 1:21:54 PM scientific session agenda
Eastern Association for the Surgery of Trauma (EAST) 26th Annual Scientific Assembly in collaboration with Society of Trauma Nurses (STN) Pediatric Trauma Society (PTS)
SCIENTIFIC SESSIONS
WEDNESDAY, JANUARY 16, 2013
7:00 am-7:50 am Sunrise Sessions 1-5 – Additional registration fees apply.
Sunrise Session 1 – Presented by the EAST Military Ad Hoc Committee Transfusion Medicine 2012 and the Military Moderator: Lt. Col. Joseph DuBose, MD Speakers: Lt. Col. Dave Zonies, MD – In Search of the Magic Ratio: What Is Known and What Is Being Studied Lt. Col. Joseph DuBose, MD – Thromboelastography Guided Resuscitation – The Way Forward?
Sunrise Session 2 – Presented by the EAST Acute Care Surgery Ad Hoc Committee Peptic Ulcer Disease: Updates in Management Moderator: Therese Duane, MD Speakers: Julie Wynne, MD, MPH – Medical Management and Operative Selection Based on Patient Factors Mary-Margaret Brandt, MD – Operative Approach Based on Indication of Perforation, Obstruction, and Hemorrhage
Sunrise Session 3 – Presented by the EAST Pediatric Ad Hoc Committee & the Pediatric Trauma Society Pediatric Massive Transfusion Protocols Moderator: Philip Spinella, MD, FCCM Speakers: Jeffrey Upperman, MD, FACS, FAAP – Massive Transfusion Protocols Philip Spinella, MD, FCCM – Research Needs to Improve MTP Related Outcomes and Implementation in Pediatric Trauma
Sunrise Session 4 – Presented by the EAST Advanced Practitioners Ad Hoc Committee Successful Billing and Coding for Advanced Practitioners Moderator: William Hoff, MD Speakers: Samir Fakhry, MD, FACS Scott P. Sherry, MS, PA-C
Sunrise Session 5 – Presented by the Society of Trauma Nurses Recognizing and Caring for the Victim of Domestic Violence Moderator: Janice Delgiorno, MSN, CCRN, ACNP-BC Speaker: Valorie K. Prulhiere, BSN, RN, SANE-A
8:00 am-8:45 am Opening Remarks and Flag Presentation
SCIENTIFIC SESSION I – RAYMOND H. ALEXANDER, MD RESIDENT PAPER COMPETITION OF THE EAST FOUNDATION Presiding: Jeffrey P. Salomone, MD, NREMT-P & Stanley J. Kurek, Jr., DO
8:50 am #1 VARIATION IN SPLENIC ARTERY EMBOLIZATION AND SPLEEN SALVAGE: A MULTICENTER ANALYSIS Presenter: Aman Banerjee, MD Discussant: Ben L. Zarzaur, MD, MPH
9:10 am #2 SHOCK INDEX AS A PREDICTOR OF MORTALITY AND RESOURCE UTILIZATION IN PEDIATRIC TRAUMA Presenter: Meade Barlow, MD Discussant: David Gourlay, MD
9:30 am #3 AMERICAN COLLEGE OF SURGEONS TRAUMA CENTER VERIFICATION VERSUS STATE DESIGNATION: ARE LEVEL II CENTERS SLIPPING THROUGH THE CRACKS? Presenter: Joshua Brown, MD Discussant: Keith Clancy, MD
9:50 am #4 DO ALL BETA BLOCKERS ATTENUATE THE EXCESS HEMATOPOIETIC PROGENITOR CELL MOBILIZATION FROM BONE MARROW FOLLOWING TRAUMA/HEMORRHAGIC SHOCK? Presenter: Latha Pasupuleti, MD Discussant: Louis Magnotti, MD
10:10 am #5 IMPROVING OVERTRIAGE OF AEROMEDICAL TRANSPORT: A REGIONAL PROCESS IMPROVEMENT INITIATIVE Presenter: Blair Wormer, MD Discussant: Mark Gestring, MD
10:30 am-10:50 am Break – Refreshments in the Exhibit Hall
SCIENTIFIC SESSION II – RAYMOND H. ALEXANDER, MD RESIDENT PAPER COMPETITION OF THE EAST FOUNDATION Presiding: Scott G. Sagraves, MD & Shreyas Roy, MD
10:50 am #6 HYPERCOAGULABILITY AFTER THERMAL INJURY Presenter: Robert Van Haren, MD Discussant: Sherry Sixta, MD
11:10 am #7 HYPERTONIC RECONSTITUTED LYOPHILIZED PLASMA IS AN EFFECTIVE LOW VOLUME HEMOSTATIC RESUSCITATION FLUID FOR TRAUMA Presenter: Tim Lee, MD Discussant: David King, MD
11:30 am #8 DOES PLASMA TRANSFUSION PORTEND PULMONARY DYSFUNCTION? A TALE OF TWO RATIOS Presenter: John Sharpe, MD Discussant: Bryce Robinson, MD
11:50 am #9 GUNS AND STATES: PEDIATRIC FIREARM INJURY Presenter: Justin Lee Discussant: John Petty, MD
12:10 pm #10 THE ACUTE CARE SURGERY MODEL: MANAGING TRAUMATIC BRAIN INJURY WITHOUT AN INPATIENT NEUROSURGICAL CONSULTATION Presenter: Hassan Aziz, MD Discussant: Daniel Yeh, MD
End of Raymond H. Alexander, MD Resident Paper Competition of the EAST Foundation
12:30 pm-1:30 pm EAST Marketplace Lunch – Lunch Provided in the Exhibit Hall
1:30 pm-2:30 pm Plenary Session Presented by the EAST Acute Care Surgery Ad Hoc Committee & Seniors Committee Old Dogs vs. Young Bucks Moderators: Therese Duane, MD & Carl Valenziano, MD, MPA
Debates: Endovascular Repair Should Be the First Line Approach for Traumatic Vascular Injuries Pro: Meghan Brenner, MD, MS Con: Walter Biffl, MD
Video-Assisted Thoracoscopy Is the Therapeutic Intervention of Choice for Retained Hemothorax and Empyema Pro: Joseph DuBose, MD Con: J. David Richardson, MD
2:30 pm-4:00 pm EAST Annual Business Meeting – Open to all EAST Members
4:00 pm-5:30 pm Parallel Plenary Session Presented by the EAST Program Committee Scientific Papers That Should Have Changed Your Practice Part III Moderator: Philip Barie, MD, MBA Speakers: Fred Luchette, MD – Critical Care Surgery Philip Barie, MD, MBA – Emergency General Surgery Kimberly Davis, MD, MBA – Trauma Surgery
4:00 pm-5:30 pm Parallel Plenary Session Presented by the EAST Advocacy & Outreach Ad Hoc Committee Advocacy 2013: Getting In, Staying Involved, and Being Prepared in the Post-Affordable Care Act Era Moderators: Bryan Cotton, MD, MPH & John Osborn, MSc Speakers: Bryan A. Cotton, MD, MPH Richard C. Hunt, MD, FACEP, Sr. Medical Advisor, National Healthcare Preparedness Program, Assistant Secretary for Preparedness and Response, Department of Health and Human Services John Osborn, MSc Lisa Tofil, Trauma Center Association of American (TCAA) Lobbyist
4:00 pm-5:30 pm Parallel Plenary Session Presented by the Society of Trauma Nurses The Burden of Urban Youth Violence: A Plea for Prevention Moderator: Joan Pirrung, RN, MSN, ACNS-BC Speakers: Glen Tinkoff, MD, FACS Detective Gregory Scheffer, Phoenix Police Department, Crimes Against Children Paul A. Carrillo, CAADCA
THURSDAY, JANUARY 17, 2013
7:00 am-7:50 am Sunrise Sessions 6-10 – Additional registration fees apply.
Sunrise Session 6 – Presented by the EAST Military Ad Hoc Committee 2012 – The Year in Combat Moderator: Lt. Col. Joseph DuBose, MD Speaker: Col. Kirby Gross, MD
Sunrise Session 7 – Presented by the EAST Acute Care Surgery Ad Hoc Committee Billing and Coding the Complex Acute Care Surgical Cases Moderators: Therese Duane, MD Speakers: Thomas Esposito, MD, MPH – Billing Complex Emergency Surgical Cases R. Lawrence Reed, II, MD – Billing and Coding the ICU and ED Dolores D. Carey, CCS-P
Sunrise Session 8 – Presented by the EAST Pediatric Trauma Ad Hoc Committee & the Pediatric Trauma Society Pediatric Trauma Jeopardy Moderator: Diane Hochstuhl, MSN, RN, NP-C Speaker: Karen Santucci, MD
Sunrise Session 9 – Presented by the EAST Practice Management Guidelines Ad Hoc Committee How to Create, Understand, and Use Practice Management Guidelines Moderators: John Como, MD, FACS & Elliott Haut, MD, FACS Speakers: Elliott Haut, MD, FACS – The Purpose of Practice Management Guidelines John Como, MD, FACS – The Practical Side of Creating a Practice Management Guideline Andrew Kerwin, MD, FACS – Making the Grade with GRADE: Evidence Quality Grading Scales
Sunrise Session 10 – Presented by the Society of Trauma Nurses Medications and Trauma: How Do You Combine Them To Make Them Work? Moderator: Elizabeth Seislove, RN, MSN, CCRN Speakers: Michael Metzler, MD Marilyn Bartley, RN, FNP-BC
SCIENTIFIC SESSION III-A – Clinical Trauma Surgery Presiding: Nicole A. Stassen, MD & Andrew Bernard, MD
8:00 am # 11 DILUTING THE BENEFITS OF HEMOSTATIC RESUSCITATION: A MULTI-INSTITUTIONAL ANALYSIS Presenter: Juan Duchesne, MD Discussant: Donald Jenkins, MD
8:20 am #12 A PROSPECTIVE RANDOMIZED STUDY OF 14-FRENCH (14F) PIGTAIL CATHETERS VS. 28F CHEST TUBES IN PATIENTS WITH TRAUMATIC PNEUMOTHORAX: IMPACT ON TUBE-SITE PAIN AND FAILURE RATE Presenter: Narong Kulvatunyou, MD Discussant: David King, MD
8:40 am #13 TRANSFUSION OF RED BLOOD CELLS IN PATIENTS WITH A PRE-HOSPITAL GCS ≥ 8 AND NO EVIDENCE OF SHOCK IS ASSOCIATED WITH WORSE OUTCOMES Presenter: Joel Elterman, MD Discussant: Mayur Patel, MD
9:00 am #14 OUTCOMES OF THE MECHANICALLY VENTILATED TRAUMA PATIENT AT THE REGIONAL TRAUMA CENTER Presenter: Jerry Rubano, MD Discussant: Nathan Mowery, MD
9:20 am #15 DIRECT PERITONEAL RESUSCITATION MAY ATTENUATE LIVER INJURY AFTER HEMORRHAGIC SHOCK Presenter: Jason Smith, MD Discussant: Greta Piper, MD
SCIENTIFIC SESSION III-B – COX-TEMPLETON INJURY PREVENTION PAPER COMPETITION OF THE EAST FOUNDATION Presiding: John M. Templeton, Jr., MD & A. Britton Christmas, MD
8:00 am #16 CHOICE OF MOTORCYCLE HELMET MAKES A DIFFERENCE: A PROSPECTIVE OBSERVATIONAL STUDY Presenter: Brian Brewer, MD Discussant: Adil Haider, MD
8:20 am #17 FEASIBILITY AND SAFETY OF A NOVEL IN VIVO MODEL TO ASSESS PLAYGROUND FALLS IN CHILDREN Presenter: Peter Ehrlich, MD, MSc, HBSc Discussant: Jason Smith, MD
8:40 am #18 THE DEVELOPMENT AND 1-YEAR ASSESSMENT OF A NOVEL PROTOCOL FOR REPORTING IMPAIRED DRIVERS FOR POSSIBLE DRIVERS LICENSE REVOCATION Presenter: Eric Mahoney, MD Discussant: Alexander Eastman, MD
9:00 am #19 PILOT EVALUATION OF THE SHORT TERM EFFECT OF DRIVING SIMULATION ON NOVICE ADOLESCENT DRIVERS Presenter: Akpofure Peter Ekeh, MD Discussant: Thomas Hayward, MD
9:20 am #20 ADOLESCENT PERCEPTIONS OF DANGEROUS DRIVING FOLLOWING EXPOSURE TO MOCK CRASHES Presenter: Chris McGrath, RN Discussant: Melissa Harte, RN, MS
End of Cox-Templeton Injury Prevention Paper Competition of the EAST Foundation
9:40 am-10:00 am Break – Visit the Exhibits – Refreshments provided in the Exhibit Hall Special Announcements & Raffle
10:00 am-11:00 am Scott B. Frame, MD Memorial Lecture of the EAST Foundation Norman E. McSwain, Jr., MD, FACS, NREMT-P
11:00 am-12:00 pm Plenary Session Presented by the Research Ad Hoc Committee Teach and Learn/Learn and Teach – Mentorship and Your Professional Development Moderator: Vicente Gracias, MD
EAST Mentors & Mentor Fellows Kimberly Nagy, MD & Paula Ferrada, MD Mayur Patel, MD, MPH & Joshua Brown, MD Ben L. Zarzaur, MD, MPH & Tanya Zakrison, MD, FRCSC
12:00 pm-1:00 pm Lunch on Your Own 1:00 pm-2:00 pm EAST Annual Oriens Presentation 1:00 pm-1:45 pm Keynote Address – C. William Schwab, MD, FACS 1:45 pm-2:00 pm EAST Oriens Essay Presentation – Charity Evans, MD
2:00 pm-5:00 pm EAST Practice Management Guidelines Plenary Session Presented by the EAST Practice Management Guidelines Ad Hoc Committee Moderator: Elliott R. Haut, MD, FACS
Review and Summary of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Approach – The Current Methodology Being Used by EAST for Practice Management Guidelines
Practice Management Guidelines Presentations Subject to Change
New Practice Management Guidelines • Emergency Department Throacotomy – Mark Seamon, MD • Management of Perforated Duodenal Ulcers – Felix Lui, MD • Clostridium Dificle Colitis – Paula Ferrada, MD • Necrotizing Soft Tissue Infections – Addison May, MD • Geriatric Fall Prevention – Robert Barraco, MD, MPH • Pediatric Blunt Abdominal Trauma – Richard Falcone, Jr., MD
Updated Practice Management Guidelines • Blunt Aortic Injury – Nicole Fox, MD • Diagnosis and Treatment of Pancreatic Trauma – Faran Bokhari, MD • Diagnosis and Management of Injury in Pregnancy – Stephanie Goldberg, MD • Blunt Cerebrovascular Injury (BCVI) – Nicole Stassen, MD • Penetrating Colon Injury – Daniel Cullinane, MD • Pain Management in Blunt Thoracic Trauma – Michael Ditillo, MD
FRIDAY, JANUARY 18, 2013
7:00 am-7:50 am Sunrise Sessions 11-15 – Additional registration fees apply.
Sunrise Session 11 – Presented by the EAST Military Ad Hoc Committee & the EAST Publications Committee Before and After…Civilian Adaptation from Military Experience Moderator: Lt. Col. Joseph DuBose, MD Speakers: Col. Matthew Martin, MD – Past, Present, and Future: Topical and Systemic Hemostatic Adjuncts Norman E. McSwain, Jr., MD, FACS, NREMT-P – Pre-Hospital Resuscitation-Civilian Adaptation
Sunrise Session 12 – Presented by the EAST Publications Committee In an Era of Damage Control Resuscitation, When Is the Best Time to Close the Abdomen? Moderator: Juan Duchesne, MD Speakers: Michael Rotondo, MD – Leave the Abdomen Open after Initial DCS Peter Rhee, MD – Close the Abdomen after Initial DCS Bryan Cotton, MD – New ICU Fluid Resuscitation Strategies for DCS Patients John P. Hunt, III, MD, MPH – A Word of Wisdom
Sunrise Session 13 – Presented by the EAST Online Education Ad Hoc Committee Special Issues in Pediatric Trauma Moderator: Andrew Bernard, MD Speakers: Michael Nance, MD – Advanced Pediatric Imaging Richard Falcone, Jr., MD, MPH – Advanced Pediatric Thoracic Trauma David Mooney, MD – Advanced Pediatric Resuscitation
Sunrise Session 14 – Presented by the EAST Injury Control & Violence Prevention Committee Distracted Driving: How Do We Wreck This Deadly Habit? Moderator: A. Britton Christmas, MD, FACS Speakers: A. Britton Christmas, MD, FACS – What Is Distracted Driving and Who Are the Offenders? Pina Violano, MSPH, RN-BC – Phone in One Hand – Ticket in the Other: Connecticut’s Distracted Driving Enforcement Project A. Britton Christmas, MD, FACS – Key Elements to Decreasing Distracted Driving
Sunrise Session 15 – Presented by the Society of Trauma Nurses Practical Collaborative Trauma Research Moderator: Melissa Harte, MS, RN Speaker: Kathryn Schroeter, PhD, RN, CNOR
SCIENTIFIC SESSION IV-A – Basic Science, Education, & Performance Improvement Presiding: Therese M. Duane, MD & Juan Duchesne, MD
8:00 am #21 CHARACTERIZING VASOACTIVE MEDIATOR RELEASE DURING RESUSCITATION OF TRAUMA PATIENTS Presenter: Stephen Cohn, MD Discussant: A. Tyler Putnam, MD
8:20 am #22 PNEUMATOSIS INTESTINALIS PREDICTIVE EVALUATION SCORE (PIPES): A MULTICENTER CENTER EPIDEMIOLOGIC STUDY Presenter: Joseph DuBose, MD Discussant: Jill Watras, MD
8:40 am #23 MITOCHONDRIAL DAMPS RELEASED BY ABDOMINAL TRAUMA SUPPRESS PULMONARY IMMUNE RESPONSES Presenter: Carl Hauser, MD Discussant: Jose Pascual Lopez, MD
9:00 am #24 A PROTOCOL-DRIVEN APPROACH TO SCHEDULING EMERGENT CHOLECYSTECTOMY DECREASES HOSPITAL LOS WHILE MAINTAINING QUALITY Presenter: Stancie Rhodes, MD Discussant: John Santaniello, MD
9:20 am #25 HOSPITAL BASED TRAUMA QUALITY IMPROVEMENT INITIATIVES: FIRST STEP TOWARDS IMPROVING TRAUMA OUTCOMES IN THE DEVELOPING WORLD Presenter: Hasnain Zafar, MBBS, FRCS Discussant: Mark Seamon, MD
9:40 am #26 THE MITOCHONDRIAL MEMBRANE POTENTIAL DECREASES IN PERIPHERAL BLOOD MONOUCLEAR CELLS ALONG WITH THE INCREASE IN LACTATE LEVELS IN HYPOVOLEMIC SHOCK IN RATS Presenter: José Perales Villarroel, MD Discussant: Randall Friese, MD
SCIENTIFIC SESSION IV-B –Trauma Systems Presiding: Bryan Cotton, MD, MPH & William S. Hoff, MD
8:00 am #27 MULTIDISCIPLINARY ACUTE CARE RESEARCH ORGANIZATION (MACRO): IF YOU BUILD IT THEY WILL COME Presenter: Barbara Early, BS Discussant: Jeffrey Claridge, MD
8:20 am #28 THE IMPACT OF IMPLEMENTING A 24/7 OPEN TRAUMA BED PROTOCOL IN THE SURGICAL INTENSIVE CARE UNIT ON THROUGHPUT AND OUTCOMES Presenter: Akash Bhakta, BS Discussant: Amy McDonald, MD
8:40 am #29 A REVISED PRE-HOSPITAL TRAUMA TRIAGE PROTOCOL: SAVING PATIENTS AND RESOURCES Presenter: Katherine Kelly, MD Discussant: Tanya Zakrison, MD
9:00 am #30 FACTORS ASSOCIATED WITH HIGHER PATIENT SATISFACTION SCORES FOR PHYSICIAN CARE: WHAT DOES A 'SATISFIED' TRAUMA PATIENT LOOK LIKE? Presenter: Frederick Rogers, MD Discussant: Thomas Esposito, MD
9:20 am #31 DEDICATED SURGICAL CRITICAL CARE SERVICE LINE OFFERS OPPORTUNITY FOR ENHANCED REVENUE AND ADVANCED PRACTITIONER DEVELOPMENT Presenter: Brian Jefferson, ACNP Discussant: William Hoff, MD
9:40 am #32 BORROWING BEST PRACTICES FROM TRAUMA: AN ACUTE CARE SURGERY REGISTRY AND PI PROGRAM Presenter: Patrick Kim, MD Discussant: Preston Miller, III, MD
10:00 am-11:00 am Presidential Address The One Who Applies The First Dressing Jeffrey P. Salomone, MD, FACS, NREMT-P
11:00 am-11:15 am Gavel Exchange
11:15 am-11:30 am Special Presentations Introducing the EAST Trauma Bay – Social Media for EAST Members Bruce Crookes, MD Updates in ACS: Re-evaluating Our Perceptions 10 Years Later Matthew Lissauer, MD
11:30 am-12:00 pm EAST & EAST Foundation Awards Ceremony • Raymond H. Alexander, MD Resident Paper Competition of the EAST Foundation • Best Manuscript Award • EAST Oriens Award • John P. Pryor, MD Distinguished Service in Military Casualty Care Award • Cox-Templeton Injury Prevention Paper Award of the EAST Foundation • John M. Templeton, Jr., MD Injury Prevention Research Scholarship of the EAST Foundation • Trauma Research Scholarship of the EAST Foundation • 2012 Brandeis Scholarship Recipient of the EAST Foundation • 2013 Society of Trauma Nurses/EAST Foundation Nurse Fellow • 2013 Leadership Development Workshop Scholars Recognition
12:00 pm-1:30 pm Scientific Poster Walk Rounds
Group I Poster Professors: Jeannette M. Capella, MD, Med & Elliott R. Haut, MD
#1 ADRENOMEDULLIN LEVELS CORRELATE WITH RATES OF SEPSIS, MULTI-ORGAN SYSTEM FAILURE, AND MORTALITY, INDEPENDENTLY OF PERCENT TOTAL BODY SURFACE AREA BURNED IN BURN PATIENTS Presenter: Rafael Diaz-Flores, MD, MPH
#2 PENETRATING VIOLENCE: A CALL FOR PREVENTION Presenter: Joan Pirrung, RN, MSN, ACNS-BS
#3 MORTALITY INCREASES WITH REPEATED EPISODES OF NON-ACCIDENTAL TRAUMA IN CHILDREN Presenter: Katherine Deans, MD, MHSc
#4 ENDOTRACHEAL TUBE REPOSITIONING: HOW ACCURATE? Presenter: Ming-Li Wang, MD
#5 THE ECONOMIC IMPACT OF INTENSIVIST FELLOWSHIP TRAINING Presenter: Jeffrey Carter, MD
#6 DEATH BY NUMBERS: HOW DO TQIP AND UHC COMPARE? Presenter: Lillian Kao, MD, MS
Group II Poster Professors: Herb A. Phelan, III, MD & Weiden A. Guo, MD, PhD
#7 ADHERENCE TO PRBC TRANSFUSION TRIGGER GUIDELINES IS IMPROVED WITH ELECTRONIC CLINICAL DECISION SUPPORT Presenter: Rachael Callcut, MD, MSPH #8 OUTCOMES OF PRE-HOSPITAL VERSUS IN-HOSPITAL INTUBATION IN TRAUMA PATIENTS – DOES LOCATION MATTER? Presenter: Christopher Stephens, MD
#9 OUTCOMES FOLLOWING SUPERSELECTIVE ANGIOEMOBLIZATION FOR GASTROINTESTINAL HEMORRHAGE Presenter: David King, MD
#10 DVT IN TRAUMA PATIENTS: INJURY RELATED, NOT A MEASURE OF QUALITY OF CARE Presenter: Meredith Tinti, MD
#11 INTERMOUNTAIN RISK SCORE IS HIGHLY PREDICTIVE OF MORTALITY IN TRAUMA PATIENTS Presenter: Sarah Friend, MD, MBA
Group III Poster Professors: Richard A. Falcone, Jr., MD, MPH & Carlos J. Rodriguez, DO, MBA
#12 UNCONTROLLED HEMORRHAGIC SHOCK RESULTS IN A HYPERCOAGUABLE STATE MODULATED BY INITIAL FLUID RESUSCITATION REGIMENS Presenter: Gordon Riha, MD
#13 EVALUATION OF THE RISK OF NONCONTIGUOUS FRACTURES OF THE SPINE IN BLUNT TRAUMA Presenter: Daniel Nelson, DO
#14 INCREASED MORBIDITY AND MORTALITY OF TRAUMATIC BRAIN INJURY IN VICTIMS OF NONACCIDENTAL TRAUMA Presenter: Katherine Deans, MD, MHSc
#15 MAINTENANCE OF NORMOTHERMIA IMPROVES FUNCTIONAL OUTCOME IN SEVERE CLOSED HEAD INJURY PATIENTS Presenter: Kara Friend, MD
#16 IMPACT OF IMPLEMENTATION OF AN ACUTE CARE SURGERY SERVICE ON PERCEPTIONS OF PATIENT CARE AND RESIDENT EDUCATION Presenter: Monisha Sudarshan, MD
Group IV Poster Professors: Joseph J. DuBose, MD & Mark J. Seamon, MD
#17 VENA CAVA FILTER (VCF) RETRIEVAL RATES ARE DEPENDENT UPON PROTOCOL AND PATIENT DISPOSITION Presenter: Paul Colavita, MD
#18 COMPARISON OF AN UNVENTED (HALO®) WITH A VENTED (BOLIN™) CHEST SEAL FOR TREATMENT OF PNEUMOTHORAX (PTX) AND PREVENTION OF TENSION PTX IN A SWINE MODEL Presenter: Bijan Kheirabadi, PhD
#19 HOW SAFE IS THE BACK SEAT IN TRAFFIC CRASHES? A PROFILE OF SEVERE INJURIES AND OUTCOMES FOR RESTRAINED REAR OCCUPANTS Presenter: Tanya Charyk Stewart, MSc
#20 FINANCIAL IMPLICATION OF PROPOSED LEGISLATION ON HOSPITAL REIMBURSEMENT FOR THE INJURED DRUNK DRIVER Presenter: Patricia Pentiak, MD
#21 A NOVEL FLUOROSCOPY-FREE, RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION SYSTEM OF THE AORTA IN A PORCINE MODEL OF SHOCK Presenter: Robert Houston, IV, MD
Group V Poster Professors: Tarek S. Razek, MD & Kevin M. Schuster, MD
#22 RESCUSITATIVE THORACOTOMIES IN U.S. COMBAT CASULATIES: A TEN-YEAR REVIEW OF OPERATION ENDURING FREEDOM AND OPERATION IRAQI FREEDOM Presenter: Kevin Waldrep, MD
#23 THE INCIDENCE AND IMPACT OF PRESCRIPTION CONTROLLED SUBSTANCE USE AMONG INJURED PATIENTS AT A LEVEL ONE TRAUMA CENTER Presenter: Matthew Bozeman, MD
#24 EARLY TRAUMATIC BRAIN INJURY SCREENING IN 6,594 INPATIENT COMBAT CASUALTIES Presenter: David Zonies, MD
#25 DOES CARING FOR TRAUMA PATIENTS LEAD TO PSYCHOLOGICAL STRESS IN SURGEONS? Presenter: Ann Marie Warren, PhD
#26 NOT ALL MECHANISMS ARE CREATED EQUAL – A SINGLE- CENTER EXPERIENCE WITH THE NATIONAL GUIDELINES FOR FIELD TRIAGE OF INJURED PATIENTS Presenter: Lance Stuke, MD, MPH Group VI Poster Professors: Bruce A. Crookes, MD & Thomas J. Rohs, Jr., MD
#27 PARTIAL TRAUMA TEAM ACTIVATIONS: WHAT ARE WE IDENTIFYING? Presenter: Nathan Mowery, MD
#28 TRIAGE CRITERIA BASED ON BLUNT MECHANISM OF INJURY ARE OF LITTLE UTILITY Presenter: Cameron Best, BS
#29 EAST SURVEY: DETERMINING PRACTICE PATTERNS OF BLOOD PRODUCT TRANSFUSION IN PATIENTS WITH LETHAL BRAIN INJURY Presenter: Stancie Rhodes, MD
#30 A NOVEL FREE RADICAL STERILIZATION SYSTEM FOR BURN WOUND DISINFECTION Presenter: Benjamin Sadowitz, MD
#31 “IT TAKES A VILLAGE” TO RAISE RESEARCH PRODUCTIVITY: IMPACT OF A NURSE-LEAD TRAUMA INTERDISCIPLINARY GROUP FOR RESEARCH (TIGR) AT AN URBAN, LEVEL 1 TRAUMA CENTER Presenter: Elizabeth NeSmith, PhD, MSN, APRN-BC
Group VII Poster Professors: Rajan Gupta, MD & Peter P. Lopez, MD
#32 PROSPECTIVE DETERMINATION OF OPTIMAL ANGIOGRAPHIC PROTOCOL IN NON OPERATIVE MANAGEMENT OF HIGHER GRADE BLUNT SPLENIC INJURY Presenter: Jay Requarth, MD
#33 RELIABILITY ADJUSTMENT: A NECESSITY FOR TRAUMA CENTER RANKING AND BENCHMARKING Presenter: Zain Hashmi, MBBS
#34 USING THE CHARLSON COMORBIDITY INDEX TO PREDICT OUTCOMES IN EMERGENCY GENERAL SURGERY Presenter: Etinne St. Louis, DEC
#35 ACUTE CARE SURGICAL SERVICE: SURGEON AGREEMENT AT THE TIME OF HANDOVER Presenter: Richard Hilsden
#36 ARE WE DELIVERING TWO STANDARDS OF CARE FOR PELVIC TRAUMA? INCREASED TIME TO ANGIOEMBOLIZATION AFTER-HOURS AND ON WEEKENDS IS ASSOCIATED WITH INCREASED MORTALITY Presenter: Diane Schwartz, MD
1:30 pm Scientific Program Adjourns abstracts
Scientific Session I – Jan 16, 2013 Paper 1 8:50 AM
VARIATION IN SPLENIC ARTERY EMBOLIZATION AND SPLEEN SALVAGE: A MULTICENTER ANALYSIS
Aman Banerjee, MD, Therese M. Duane*, MD, Sean P Wilson, MD, Starre Haney, RN, MS, Patrick J. O'Neill*, PhD, MD, Heather L Evans, MD, MS, John J. Como*, MD, MPH, Jeffrey A. Claridge*, MD, MS, MetroHealth Medical Center
Presenter: Aman Banerjee, MD Discussant: Ben L. Zarzaur, MD, MPH University of Tennessee HSC
Objectives: To evaluate if variation in management of blunt splenic injury (BSI) among level 1 trauma centers is associated with different outcomes related to the use of splenic artery embolization (SAE). Methods: All adult patients admitted for BSI from 2008 to 2010 at 4 level 1 trauma centers were reviewed. Use of SAE was determined and outcomes of spleen salvage and non-operative management (NOM) failure were evaluated. A priori, a 10% SAE rate was used to group centers into high or low use groups. Results: There were 1275 BSI patients. There were inter-center differences in age, injury severity, and grade of spleen injury (SIS). Mortality was similar by center; however BSI treatment varied significantly by center. Initial SAE was highest at Center A compared to center B, C, and D (14% vs 7%, 1% and 4%,p<0.01). Overall SAE use was highest at center A compared to B, C, and D (19%, 11%, 1% and 4%,p<0.01). There were significant differences in initial splenectomy rates by center, ranging from 10% to 22% (p<0.01), with Center A having the lowest initial splenectomy rate and highest spleen salvage rate (range 73% - 86%,p<0.05). Outcomes (Table 1) were evaluated by high vs low SAE use. High SAE use centers had significantly higher spleen salvage rates and fewer NOM failures. Differences in use of SAE and salvage rate were dramatic between high and low use SAE centers for grade 3 and 4 injured spleens. In patients who received initial NOM, multivariate logistic regression analysis showed SAE was an independent predictor of spleen salvage (OR = 5; 95% CI = 1.8 – 13.5,p<0.01) as were lower age, lower SIS, and ISS. Patients treated at high SAE use centers were more likely to leave the hospital with their spleen in situ (OR = 3; 95% CI = 1.7 – 6.3,p<0.01). Conclusion: Significant practice variation exists in the use of SAE in treating BSI at level 1 trauma centers. Centers with higher rates of SAE use have higher spleen salvage and less NOM failure. SAE was shown to be an independent predictor of spleen salvage.
Notes Scientific Session I – Jan 16, 2013 Paper 2 9:10 AM
SHOCK INDEX AS A PREDICTOR OF MORTALITY AND RESOURCE UTILIZATION IN PEDIATRIC TRAUMA
Meade Barlow, MD, Lisa Rosen, Sc.M., Steven Stylianos*, MD Cohen Children's Medical Center
Presenter: Meade Barlow, MD Discussant: David Gourlay, MD, Children’s Hospital of Wisconsin
Objectives: Shock index (SI), calculated by dividing heart rate by systolic blood pressure, has been studied extensively in the setting of adult trauma and has been shown to be predictive of morbidity and mortality. However SI has not been investigated in pediatric trauma. This study examines the association between SI and mortality, the need for transfusion, operative intervention and use of angiography. Methods: Utilizing the 2009 National Trauma Data Base (NTDB), we reviewed 94,182 cases of pediatric trauma. Survival and rates of transfusion, operative intervention and use of angiography were determined. The two-sample t-test was used to compare the mean SI between groups. Logistic regression was used to model mortality as a function of SI, age, and Glasgow Coma Scale (GCS) on training data. The area under the (AUC) receiver operating characteristic (ROC) curve was used to assess the model's discrimination. A test set was used to validate these models. Results: SI was significantly higher in patients who died (1.09±0.56 vs. 0.86±0.30, p<0.001), required transfusion (1.02±0.44 vs. 0.85±0.29, p<0.001) and operative intervention (0.94±0.38 vs. 0.85±0.29, p<0.001), but not associated with angiography (p<0.176). The model, which included age, SI, GCS, and all two and three-way interactions, was predictive of mortality (AUC: 0.97). This indicates that the effect of SI on mortality risk depends on age and GCS. The misclassification rate was 6.81% in the test set. Conclusion: Using the NTDB, we demonstrated that an elevated SI is associated with an increased risk of mortality as well as the need for transfusion and operative intervention but not angiography. The SI, in addition to age and GCS, represents a powerful tool allowing physicians to identify patients at risk for severe injury requiring intervention and may allow for early identification of patients requiring a high level of care.
Notes Scientific Session I – Jan 16, 2013 Paper 3 9:30 AM
AMERICAN COLLEGE OF SURGEONS TRAUMA CENTER VERIFICATION VERSUS STATE DESIGNATION: ARE LEVEL II CENTERS SLIPPING THROUGH THE CRACKS?
Joshua Brown*, MD, Raquel M. Forsythe*, MD, Andrew B. Peitzman*, MD, Timothy Billiar, MD, Jason L. Sperry*, MD, MPH University of Pittsburgh Medical Center
Presenter: Joshua Brown, MD Discussant: Keith Clancy, MD, York Hospital
Objectives: Single center experience has shown that American College of Surgeons (ACS) trauma verification can improve outcomes. The current objective was to compare mortality between ACS verified and State designated centers in a national sample. Methods: Subjects ≥16yr from ACS verified or State designated level I and II centers were identified in the NTDB 2007-08. A predictive mortality model was constructed using TQIP methodology. Imputation was used for missing data. Probability of mortality in the model determined expected deaths. Observed to expected (O/E) mortality ratios with 90%CI and outliers (90%CI above or below 1.0) were compared across ACS and State level I and II centers. The mortality model was repeated with ACS vs. State included. Results: There were 900,274 subjects. The model had an AUC of 0.92 to predict death. Level I ACS centers had a lower median O/E ratio than State (0.95 [IQR 0.82-1.05] vs 1.02 [0.87-1.15], p<0.01), with no difference in level II centers. Level II State centers had more high O/E outliers (Table). ACS verification was an independent predictor of survival in level II centers (OR 1.26; 95%CI 1.20-1.32, p<0.01), but not in level I centers (p=0.84). Conclusion: Level II centers have a disproportionate number of high mortality outliers and ACS verification is a predictor of survival. Level I ACS centers have lower O/E ratios overall but no difference in outliers. ACS verification appears beneficial. This data suggests that level II centers benefit most, and promoting level II ACS verification may be an opportunity for improved outcomes.
ACS State OR (95%CI) p
Level I N=122 N=67
High O/E outlier 15% 24% - 0.16
Low O/E outlier 28% 16% - 0.10
Level II N=124 N=61
High O/E outlier 4% 13% 0.27 (0.09-0.89) 0.03
Low O/E outlier 23% 21% - 0.57
Notes Scientific Session I – Jan 16, 2013 Paper 4 9:50 AM
DO ALL BETA BLOCKERS ATTENUATE THE EXCESS HEMATOPOIETIC PROGENITOR CELL MOBILIZATION FROM BONE MARROW FOLLOWING TRAUMA/HEMORRHAGIC SHOCK?
Latha V Pasupuleti, MD, Ziad C. Sifri*, MD, Kristin M Cook, MD, Gabriel M Calderon, BA, Walter D Alzate, MS, David H. Livingston*, MD, Alicia M. Mohr*, MD, UMDNJ-NJMS
Presenter: Latha V Pasupuleti, MD Discussant: Louis Magnotti, MD Univeristy of Tennessee HSC Objectives: Severe injury results in increased mobilization of hematopoietic progenitor cells (HPC) from the bone marrow (BM) to sites of injury. Norepinephrine induces HPC mobilization and non-selective beta blockade with propranolol has been shown to decrease mobilization. This study investigated selective beta adrenergic receptor blockers (B1B, B2B, B3B) in HPC mobilization following lung contusion (LC) and hemorrhagic shock (HS). Methods: Male Sprague-Dawley rats were subjected to LC followed by 45 minute of HS. Animals (n=6/group) were then randomized to either receive atenolol (LCHS+B1B), butoxamine (LCHS+B2B), or SR59230A (LCHS+B3B) immediately after resuscitation. BM cellularity, % HPCs in peripheral blood, and plasma G-CSF levels were assessed at 3 hours post LCHS. Plasma from all groups was plated with normal BM to assess its systemic effect on HPC growth. Injured lung tissue was evaluated histologically and a lung injury score calculated. All groups were compared to control animals. *p < 0.05 vs. LCHS with ANOVA and Tukey-Kramer. Results: B2B or B3B following LCHS restored BM cellularity and significantly decreased HPC mobilization (Table). In contrast, B1B had no effect on any parameter examined. Only B3B reduced plasma G-CSF. When evaluating the plasma systemic effects, both B2B and B3B significantly improved BM HPC growth as compared to LCHS alone. The use of B2 and B3 blockade improved lung injury scores 3 hours after LCHS. Conclusion: B2 and B3, but not B1 adrenergic receptors, are involved in excess HPC mobilization following trauma and HS. Treatment with B3 blockade reduced plasma G-CSF levels compared to B2, suggesting different mechanisms for adrenergic induced G-CSF release. Use of B2 and/or B3, but not B1 blockade, is a potential strategy to reduce BM dysfunction and reduce lung injury following trauma and HS.
Notes Scientific Session I – Jan 16, 2013 Paper 5 10:10 AM
IMPROVING OVERTRIAGE OF AEROMEDICAL TRANSPORT: A REGIONAL PROCESS IMPROVEMENT INITIATIVE
Blair A Wormer, MD, Greg Flemming, RRT, A. Britton Christmas*, MD, FACS, Ronald F. Sing*, DO, Michael H. Thomason*, MD, Toan T. Huynh*, MD, Carolinas Medical Center
Presenter: Blair A Wormer, MD Discussant: Mark Gestring, MD, University of Rochester
Objectives: Objectives: Aeromedical transport (AMT) is an effective, but costly means of rescuing critically injured patients. Recent studies have shown it improves survival to hospital discharge compared to ground transportation in Level I and II trauma admissions. However, an efficient threshold for this mode of transport remains to be established as universal criteria for AMT triage remains to be determined. Herein, we examined the effect of implementing a Trauma Advisory Committee (TAC) initiative focused on reducing AMT overtriage rates. Methods: Methods: TAC outreach coordinators (OC) implemented a process improvement (PI) initiative and collected data prospectively from January 2007 to March 2012. Over triage was defined as patients who were airlifted and later discharged from the emergency department. Serving as liaisons to surrounding counties, TAC OC conducted quarterly PI meetings with local EMS agencies. Patients were grouped into those who were airlifted from TAC counties, versus counties outside TAC's jurisdiction (NON). Differences between groups were compared by Mann-Whitney Rank Sum test. Results: Results: Overall, 3454 patients were airlifted from 19 counties. After implementation, the total AMT and overtriage rates from TAC counties declined compared to NON counties. The reduction in overtriage continued over the study duration. Conclusion: Conclusions: Implementation of a regional TAC PI initiative focused on overtriage issues led to a more efficient use of aeromedical transport.
Notes Scientific Session II – Jan 16, 2013 Paper 6 10:50 AM
HYPERCOAGULABILITY AFTER THERMAL INJURY
Robert M. Van Haren, M.D., Chad M. Thorson, M.D., Emiliano Curia, M.D., Alex M. Busko, B.S., Gerardo A. Guarch, M.D., Jose M. Barrera, M.D., David M. Andrews, M.D., Louis R. Pizano*, MD, Carl I. Schulman*, MD, MSPH, Nicholas Namias*, MD, Kenneth G. Proctor*, PhD, University of Miami Miller School of Medicine
Presenter: Robert M. Van Haren, M.D. Discussant: Sherry Sixta, MD, Cooper University Hospital
Objectives: Virchow's triad describes three factors that contribute to venous thromboembolism (VTE): hypercoagulability, stasis, and endothelial injury. Compared to other surgical patients, burn patients are considered low risk for VTE. We tested the hypothesis that burn patients are not hypercoagulable at admission or during recovery. Methods: A prospective trial was conducted at an ABA verified Burn Center. Blood was drawn from indwelling catheters upon ICU admission, and weekly for those who remained hospitalized, and analyzed immediately with Thromboelastography (TEG). Routine and special coagulation tests were performed on stored plasma samples. Data are shown as median (IQR). Results: 19 patients (84% male) were enrolled, age 46 (20) years, TBSA 29 (23)%, 16 suffered thermal burns (4 inhalational injuries) and 3 had electrical burns. 15 patients had repeat samples a week after ICU admission. The repeat TEG was more hypercoaguable: increased angle, maximum amplitude (MA), and clot firmness (G) (all p<0.05). D-Dimer, protein C activity (PC ACT), protein S activity (PS ACT), and antithrombin III (AT III) were increased, suggesting a procoagulant state (all p<0.05) (Table 1). These changes cannot be attributed to hemoconcentration as fluid balance was more positive and hematocrit was lower on repeat samples (all p<0.05). Two patients (11%) developed VTE and their initial clotting time (R), fibrinogen, and partial thromboplastin time (PTT) were decreased (all p<0.05) compared to those with no VTE (Table 2). All changes occurred despite pharmacologic thromboprophylaxis. Conclusion: This is among the first studies to show that burn patients could have a greater susceptibility to VTE than previously recognized. Burn patients are hypercoagulable during recovery based on TEG and laboratory value. Additional monitoring and/or thromboprophylaxis may be indicated.
Notes Scientific Session II – Jan 16, 2013 Paper 7 11:10 AM
HYPERTONIC RECONSTITUTED LYOPHILIZED PLASMA IS AN EFFECTIVE LOW VOLUME HEMOSTATIC RESUSCITATION FLUID FOR TRAUMA
Tim H Lee, MD, Kate Watson, BS, Jerome A Differding, MPH, Loic Fabricant, MD, Jeffrey Barton, MD, Igor Kremenevskiy, MD, PhD, Claire Sands, CVT, Martin A. Schreiber*, MD, FACS, Oregon Health and Science University
Presenter: Tim H Lee, MD Discussant: David King, MD, Massachusetts General Hospital
Objectives: We performed this study to optimize reconstituted lyophilized plasma (LP) into a minimal volume fluid that provides effective hemostatic resuscitation for trauma while minimizing logistical limitations. Methods: We performed a prospective, blinded animal study. Plasma was lyophilized following whole blood collection from anesthetized swine. The minimal volume needed for reconstitution was determined and this solution was evaluated for safe infusion into swine. Reconstituted LP was analyzed for electrolyte content, osmolarity, and coagulation factor activity. Twenty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock (including a Grade V liver injury), then randomized to resuscitation with LP reconstituted to either 100% of the original plasma volume (100%LP) or the minimal volume LP fluid. Physiologic data were monitored, and blood loss and hematocrit were measured. Coagulation status was evaluated using thrombelastography (TEG). Results: The minimal volume of reconstituted LP safe for infusion in swine was 50% of the original plasma volume (50%LP). The 50%LP had higher electrolyte concentrations, osmolarity, and increased coagulation factor activity levels by volume compared to 100%LP (p < 0.05). Blood loss, hematocrit (Hct), mean arterial pressure (MAP), and heart rate (HR) did not differ between animals receiving 100%LP (n=10) or 50%LP (n=10) at any time point (p > 0.05). TEG parameters were not different between groups (R time, K, α – angle, or MA, p > 0.05). Conclusion: Resuscitation with 50%LP fluid was well tolerated and equally effective compared to 100%LP with respect to physiologic and hemostatic properties. The smaller volume of fluid necessary to reconstitute hypertonic LP makes it logistically superior to 100%LP for first responders and may reduce adverse effects of large volume resuscitation.
Notes Scientific Session II – Jan 16, 2013 Paper 8 11:30 AM
DOES PLASMA TRANSFUSION PORTEND PULMONARY DYSFUNCTION? A TALE OF TWO RATIOS
John P. Sharpe, MD, Jordan A. Weinberg*, MD, Louis J. Magnotti*, MD, Timothy C. Fabian*, MD, Martin A. Croce*, MD, Department of Surgery, University of Tennessee Health Science Center
Presenter: John P. Sharpe, MD Discussant: Bryce Robinson, MD, University of Cincinnati
Objectives: An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma to RBC ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma:RBC on P/F ratio in the setting of massive transfusion (MT). Methods: Over a 5.5 year period, prospective data were collected on trauma patients who underwent MT, defined as ≥10 unit RBC transfusion by completion of hemorrhage control. Deaths within 48h of arrival were excluded. Acute lung injury (ALI) and ARDS were defined as P/F ratio <300 and <200 at 48h respectively. Stepwise multiple regression analysis was performed to determine variables significantly associated with P/F ratio. Results: 199 patients met inclusion criteria. 159 (80%) developed ALI and 105 (53%) developed ARDS. ALI and ARDS were both associated with subsequent mortality: ARDS (24%) vs. no ARDS (2.5%), p <0.05; ALI (21%) vs. no ALI (2.5%), p <0.05. Paradoxically, patients with P/F ratio ≥300 were found to have received more plasma (5.6 vs. 4.3 units, p <0.05) and higher plasma to RBC ratio (1:2 vs. 1:3, p <0.05) at completion of hemorrhage control. Stepwise multiple regression analysis, however, identified age (p <0.001) and chest AIS (p = 0.04), but not plasma:RBC (p = 0.10) to be independent determinants of P/F ratio at 48 hours. Conclusion: In this cohort of MT patients who survived beyond the first 48 hours, pulmonary dysfunction developed in the majority, and was associated with a 10-fold higher risk of subsequent death. However, plasma to RBC ratio achieved during hemorrhage control had neither a positive nor negative impact on subsequent P/F ratio. Liberal transfusion of plasma-rich components in the MT setting may not, in fact, be deleterious to lung function.
Notes
Scientific Session II – Jan 16, 2013 Paper 9 11:50 AM
GUNS AND STATES: PEDIATRIC FIREARM INJURY
Justin Lee, Kevin P Moriarty*, MD, David Tashjian, MD, FACS, FAAP, Lisa A. Patterson*, MD, St. Elizabeth Medical Center, Tufts University School of Medicine
Presenter: Justin Lee Discussant: John Petty, MD, Wake Forest School of Medicine Objectives: A recent report indicates that firearm-related injuries are responsible for 30% of pediatric trauma fatality. The literature is however limited in examining pediatric firearm injuries and variations in state gun control laws. Therefore, we sought to examine the association between pediatric firearm injuries and the Stand-Your-Ground (SYG) and Child-Access Protection (CAP) laws. Methods: All pediatric (age 0-20 years) hospitalizations with firearm injuries were identified from the Kids' Inpatient Database from 2006 and 2009. States were compared for SYG and CAP laws. Results: A total of 19,233 firearm injury hospitalizations were identified with 64.7% assault, 27.2% accidental, and 3.1% suicide injury. Demographics for assault injury were: mean age of 17.57 years, 88.4% male, 44.4% black, 18.2% Hispanic, 70.5% from metropolitan areas, and 50.1% from the poorest median income neighborhoods. Suicide injury cases were more likely to be white (57.8% vs 16.6%, P<0.001) and female (15.1% vs 9.8%, P<0.001). States with the SYG law were associated with increased assault injury (OR 1.274, P<0.001). There was no statistical association between CAP law and the incidence of accidental injury or suicide. Multivariate logistic regression analysis found other predictive demographic factors for assault firearm injury: black (OR 4.322, P<0.001), Hispanic (OR 1.839, P<0.001), metropolitan areas (OR 2.038, P<0.001), poorest median income neighborhoods (OR 1.598, P<0.001), male (OR 36.870, P<.001), and age > 16 years (OR 70.273, P<.001). Total economic burden was estimated at more than $1 billion dollars with a median length of stay of 3 days, 8.4% discharge to rehab, and 6.2% in-hospital mortality. Conclusion: A significant increase in assault injuries in states with the SYG law may highlight inadvertent effects of the law. Race, gender, and median income are additional significant factors. Advocacy and focused educational efforts for specific socioeconomic and racial groups can potentially reduce firearm injuries.
Notes Scientific Session II – Jan 16, 2013 Paper 10 12:10 PM
THE ACUTE CARE SURGERY MODEL: MANAGING TRAUMATIC BRAIN INJURY WITHOUT AN INPATIENT NEUROSURGICAL CONSULTATION
Hassan Aziz, MD, Bellal Joseph*, MD, Moutamn Sadoun, MD, Narong Kulvatunyou*, MD, Andrew L. Tang*, MD, Terence S. O'Keeffe*, MB ChB, MSPH, Julie L. Wynne*, MD, MPH, Lynn Gries, Donald Green, Randall S. Friese*, MD, Peter Rhee*, MD, MPH, The University of Arizona
Presenter: Hassan Aziz, MD Discussant: Daniel Yeh, MD, Massachusetts General Hospital
Objectives: Neurosurgical services are a limited resource and effective use of them would improve the health care system. Acute care surgeons (ACS) are accustomed to treating mild traumatic brain injury (TBI) including those with minor radiographic intracranial injuries. We hypothesized that ACS safely manage mild TBI without an inpatient neurosurgical consultation (INC). Methods: We performed a retrospective analysis of all TBI patients with positive findings on head computed tomography (CT) scan managed without INC over a two year period. Propensity scoring matched INC to No-INC patients on a 1:1 ratio for age, Glasgow Coma Scale (GCS) Score, head Abbreviated Injury Scale (h-AIS) Score, Injury Severity Score (ISS), neurologic exam, skull fracture ,and Intracranial hemorrhage (ICH) was performed. Results: 180 patients with TBI and positive CT scan findings were included (90: INC and 90: No-INC). 63% were male and mean age was 39±25 years. The median GCS was 15[12-15] and Head AIS 2[1-5]. For both groups, there was no neurosurgical intervention or 30 day re-admission rate. In the No-INC group 8% of the patients had post discharge ED visits compared to 2% of the INC group (p=0.5). All patients with post discharge ED visits in both groups were discharged home from the Emergency Department. Conclusion: Acute care surgeons can and should manage mild TBI without obtaining an inpatient neurosurgical consultation. Further Guidelines should be established to help identify which patients meet criteria to be safely managed without consultation
Notes Scientific Session III-A – Jan 17, 2013 Paper 11 8:00 AM
DILUTING THE BENEFITS OF HEMOSTATIC RESUSCITATION: A MULTI-INSTITUTIONAL ANALYSIS
Juan C. Duchesne*, MD, FACS, FCCP, Chrissy Guidry, DO, Jiselle Heaney, M.D., M.P.H., Norman E. McSwain*, MD, FACS, NREMTP, Peter Meade*, MD, MPH, Mitchell Cohen*, M.D., Martin A. Schreiber*, MD, FACS, Kenji Inaba, MD, Dimitra Skiada, M.D., John B. Holcomb*, MD, Charles Wade, M.D., Bryan A. Cotton*, MD, Tulane University School of Medicine
Presenter: Juan C. Duchesne, MD, FACS, FCCP Discussant: Donald Jenkins, MD, Mayo Clinic
Objectives: Although minimization of crystalloids is widely adopted, its impact on High Ratio Resuscitation (HRR) has not been analyzed. We hypothesize that HRR patients have worse outcomes from crystalloid use. Methods: 4 year retrospective Multi Institutional Analysis (MIA) of patients with ≥10 units of PRBC/24 hrs. FFP:PRBC groups: High (1-1:2) and Low (<1:2). Crystalloid volume was recorded. Analysis included: KM survival curves and multiple logistic regression for mortality and morbidity prediction. Results: 5 centers participated with 451 patients. Ratios: High n=365 (80.9%) vs. Low n=86 (19.0%). 24 hour KM survival for the High vs. Low was 85.2% vs. 68.6% (p=0.0004). Volume of crystalloid KM survival curve in High Ratio group was not significant for mortality (FIG.). Morbidity odds ratios (CI 95%) were not significant for High Ratio but were for crystalloids: bacteremia 1.05(1.0-1.1), ARDS 1.13(1.0-1.2), and ARF 1.05(1.0-1.1). Conclusion: Our results support previous studies with decreased mortality in HRR group. This is the first MIA to demonstrate increased morbidity from crystalloid use in HRR. Within HRR, the ratio was not a predictor of morbidity but crystalloids were. Caution in crystalloid use in HRR is warranted.
Notes Scientific Session III-A – Jan 17, 2013 Paper 12 8:20 AM
A PROSPECTIVE RANDOMIZED STUDY OF 14-FRENCH (14F) PIGTAIL CATHETERS VS. 28F CHEST TUBES IN PATIENTS WITH TRAUMATIC PNEUMOTHORAX: IMPACT ON TUBE-SITE PAIN AND FAILURE RATE
Narong Kulvatunyou*, MD, Lisa Erickson, Randall S. Friese*, MD, Donald Green, Lynn Gries, Bellal Joseph*, MD, Terence S. O'Keeffe*, MB ChB, MSPH, Peter Rhee*, MD, MPH, Andrew L. Tang*, MD, Julie L. Wynne*, MD, MPH, University of Arizona
Presenter: Narong Kulvatunyou, MD Discussant: David King, MD, Massachusetts General Hospital
Objectives: Small 14-French (14F) pigtail catheters (PCs) works as well as the traditional large-bore 28-40F chest tubes (CTs), particularly in patients with traumatic pneumothorax (PTX). We hypothesized those PCs, while function equally well, have less tube-site pain than CTs Methods: We performed a prospective randomized study, comparing 14F PCs and 28F CTs in patients seen at our Level I trauma center with traumatic PTX from July 2010 to February 2012. Excluded were patients who required emergency PC or CT placement; those who refused to consent to participate in the study; and those who were unable to respond to pain assessment. The PCs were placed at bedside by the trauma team using a modified Seldinger technique. The primary outcome measures were tube-site pain, as assessed by a visual analog scale (VAS), and total pain medication use. The secondary outcomes included the failure rate and the insertion-related complications. For our statistical analysis, we used the unpaired Student t-test, the χ2 (chi-square) test, and the Wilcoxon rank-sum test; we defined significance by a p value < 0.05. Results: During the study period, 74 patients were eligible to participate; however, after exclusion, 40 patients were enrolled. The baseline characteristics of the PC and CT patients (20 in each group) were similar. Results are summarized in the table. Conclusion: In patients with traumatic PTX, we found that 14F PCs are safe and functions as well as 28F CTs with significantly less tube-site pain. PCs may have a role for other traumatic indications.
Notes Scientific Session III-A – Jan 17, 2013 Paper 13 8:40 AM
TRANSFUSION OF RED BLOOD CELLS IN PATIENTS WITH A PRE-HOSPITAL GCS ≤ 8 AND NO EVIDENCE OF SHOCK IS ASSOCIATED WITH WORSE OUTCOMES
Joel Elterman*, M.D., Karen Brasel, M.D., Siobhan Brown, PhD, Eileen Bulger*, M.D., Jim Christenson*, M.D., Jeffrey D. Kerby*, MD, PhD, Joseph P. Minei*, MD, FACS, Sandro Rizoli*, MD, PhD, FRCSC, FACS, Martin A. Schreiber*, MD, FACS, Oregon Health & Science University
Presenter: Joel Elterman, MD Discussant: Mayur Patel, MD, Vanderbilt University Medical Center
Objectives: Red blood cell transfusion practices vary and the optimal hemoglobin for patients with TBI has not been established. We sought to identify the interaction between initial hemoglobin and red cell transfusion on 28-day survival, ARDS free survival, MODs score, and 6-month GOSE in a cohort of patients with a pre-hospital GCS less than or equal to 8 and no evidence of shock. Methods: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving EMS agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a GCS ≤ 8 without evidence of shock (defined by a SBP <70 or SBP of 70-90 with HR ≥ 108), the association of red cell transfusion with 28-day survival, ARDS free survival, MODs score and 6 month GOSE was modeled using multivariable logistic regression with robust standard errors adjusting for age, sex, ISS, initial GCS, initial SBP, highest field HR, penetrating injury, fluid use, study site and Hgb. Results: 1158 patients had a mean (m) age of 40, 76% were male and 98% suffered blunt trauma. The initial GCS (m) was 5 and initial SBP (m) was 134. The head AIS (m) was 3.5. Table 1 includes the odds ratio (OR) per unit of blood given in the first 24 hours for 28 day survival, ARDS free survival and 6-month GOSE >4 stratified by initial Hgb level. When the initial Hgb was > 10, each unit of blood transfused increased the MODs score by 0.45 (Co-efficient 95% CI [0.19,0.70] p-value<0.01). Conclusion: In patients with a suspected TBI and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial hemoglobin was > 10. There was no relationship between blood transfusion and outcomes in the patients with initial hemoglobin ≤ 10.
Notes Scientific Session III-A – Jan 17, 2013 Paper 14 9:00 AM
OUTCOMES OF THE MECHANICALLY VENTILATED TRAUMA PATIENT AT THE REGIONAL TRAUMA CENTER
Jerry A Rubano, MD, Jane E. McCormack*, RN, BSN, Michael Paccione*, Marc Shapiro, MD, Stony Brook University Medical Center
Presenter: Jerry A Rubano, MD Discussant: Nathan Mowery, MD, Wake Forest School of Medicine
Objectives: The correlation between large hospital volumes and improved outcomes in mechanically ventilated patients is well known. This investigation sought to determine the relationship between trauma center volume and outcome after prolonged MV. Methods: Retrospective analysis of county wide population-based trauma registry. Area reviewed was a suburban county of 1.5 million, served by 11 hospitals (1 Regional Trauma Center [RTC], 4 Area Trauma Centers [ATC] and 6 Non-Trauma Centers [NTC]). Adults (age > 17), with moderate to severe traumatic injury, who were ventilated for > 96 hours were included. The study compared RTC versus the combined group of ATC and NTC. The patient characteristics (age, gender, co-morbidities), injury characteristics (mechanism of injury, GCS, ISS), outcome (mortality, ventilator days, ICU days, hospital days) were compared. Chi-square and Student T-test were performed to predict the outcome between the two groups; a multivariate logistic analysis was performed. Results: 715 patients met study criteria: 407 at RTC and 308 at other hospitals. RTC patients were younger (48.6 v 54.4., p <0.001) and more severely injured (mean ISS 31.5 v 22.2, p < 0.001) than those at other hospitals. There was no significant difference in gender and co-morbidities between the groups. The hospital mortality was significantly lower (17% v 34%) in patients treated in RTC. Shorter hospitals stays and shorter ventilator days were found in RTC group, but no difference in ICU LOS. Conclusion: Here, the high volume center correlated with the highest level of trauma center designation. Treatment at RTC strongly correlated with improved outcomes in trauma patients requiring prolonged MV. Multivariate logistic analysis demonstrated that treatment at a RTC was associated with improved mortality (OR 0.396, p<.001). Pre-existing coagulopathy, increasing age and ISS and decreasing GCS were associated with higher mortality. Transfer of patients requiring prolonged MV to RTC would improve mortality.
Notes Scientific Session III-A – Jan 17, 2013 Paper 15 9:20 AM
DIRECT PERITONEAL RESUSCITATION MAY ATTENUATE LIVER INJURY AFTER HEMORRHAGIC SHOCK
Jason Smith*, MD, Matthew Benns*, MD, Glen A. Franklin*, MD, Brian G. Harbrecht*, MD, Paul J Matheson, PhD, R Neal Garrison, MD, University of Louisville
Presenter: Jason Smith, MD Discussant: Greta Piper, MD, Yale School of Medicine
Objectives: : Hemorrhage due to trauma is a leading cause of death in people under 35 years of age. Despite adequate restoration of central hemodynamics, end organ perfusion often continues to be compromised leading to end organ failure and late death. Direct Peritoneal Resuscitation (DPR) has been shown to improve visceral blood flow. Our objective of this study is to translate these innovative laboratory findings into clinical practice in damage control surgery (DCS) patients. Methods: Forty-two (42) DCS patients were enrolled over a 4 year (2008-2011) period to undergo DPR in addition to standard resuscitation as part of a prospective case-control study. DPR consisted of peritoneal lavage with 2.5% Deflex solution (a commercially available peritoneal dialysis solution) at a predetermined rate while the abdomen was temporarily closed. Patients were matched against 42 case controls for ISS, type of injury, age, gender and AIS of head and abdominal injury. Univariate and Multivariate analysis was performed. Results: Patients undergoing DPR had a more rapid normalization of liver enzymes after hemorrhagic shock (Table 1). Also, DPR patients had a lower total transfusion requirement at 48 hours compared to controls. (31 ±14 vs. 39 ±15, p =0.021). Transfusion ratios (RBC:FFP) in the first 24 hours were no different between the two groups (1.76 vs 1.57, p=0.52). DPR patients had a shorter time to abdominal closure (3.6 ±2.1 vs. 5.7 ±3.2, p=0.003) and fewer abdominal complications compared to controls. Mortality between the groups showed a lower overall mortality at 30 days for the DPR group compared to conventional resuscitation (10% vs 14%, p=0.17). Multivariate Analysis showed that DPR was associated with more rapid correction of liver enzymes as well as a more rapid abdominal closure rate. Conclusion: DPR may attenuate liver injury after hemorrhagic shock. This may lead to less overall transfusion requirements, faster abdominal closure, fewer complications and better outcomes for patients.
Notes Scientific Session III-B – Jan 17, 2013 Paper 16 8:00 AM
CHOICE OF MOTORCYCLE HELMET MAKES A DIFFERENCE: A PROSPECTIVE OBSERVATIONAL STUDY
Brian L Brewer*, M.D., Alex Diehl, M.D., Laura S Johnson*, MD, Jeffrey P. Salomone*, MD, FACS, NREMT-P, David V. Feliciano*, MD, Kenneth L Wilson, MD, Hany Atallah, M.D., Grace S. Rozycki*, MD, FACS, Emory University School of Medicine
Presenter: Brian L Brewer, MD Discussant: Adil Haider, MD, Johns Hopkins University School of Medicine
Objectives: Although many states mandate that motorcyclists wear helmets, the laws do not indicate the type of helmet that should be worn. There are no prospective studies evaluating patterns of injuries as they relate to helmet type. The hypothesis in this study was that full-face helmets reduce injuries associated with motorcycle collisions when compared to other helmet types. Methods: A prospective observational study was conducted at a Level I Trauma Center to evaluate the efficacy of helmet types relative to craniofacial injuries. Data included patient demographics, full-face helmet type (FFH) versus other helmet (OH) types (half, open face, and modular), injuries, and outcomes. The incidences of facial fractures, skull fractures and traumatic brain injuries (TBI) were compared in victims wearing FFH versus OH during motorcycle crashes. Results: From 2011-2012, 151 victims of motorcycle crashes (135 males/ 16 female; mean age of 38.4 years, range 19-74) whose helmet types were identified by EMS personnel, emergency medicine physicians, or a trauma team member were entered into the study. The distribution of helmets was 84 FFH and 67 OH (39 half and 28 modular). Facial fractures were present in 7% of the patients wearing FFH (95% CI 0.015, 0.125) versus 27% (95% CI, 0.164, 0.376) of those wearing OH (p=0.004). In addition, there were skull fractures in 1% of the patients wearing FFH versus 8% in those wearing OH (p<0.05). While there was a trend for victims wearing FFH to have a lower incidence of TBI (13% versus 25% in those wearing OH), this was not statistically significant (p=0.053). There were no differences in Injury Severity Score, length of stay, or mortality between the two groups. Conclusion: Victims of motorcycle crashes who are wearing FFH have a significant reduction in facial and skull fractures when compared to those wearing OH. Further studies will be needed to assess whether FFH will significantly decrease the incidence of TBI. Notes Scientific Session III-B – Jan 17, 2013 Paper 17 8:20 AM
FEASIBILITY AND SAFETY OF A NOVEL IN VIVO MODEL TO ASSESS PLAYGROUND FALLS IN CHILDREN
Peter Ehrlich*, MD, MSc, H BSc, Tom Armstrong, PhD, James Ashton-Miller, PhD, Bethany Buschman, Ms, Andrzej Galecki, MD PhD, Sheryl Ulin, PhD, Charles Wolley, MS, Justin Young, PhD, University of Michigan
Presenter: Peter Ehrlich, MD, MSc, H BSc Discussant: Jason Smith, MD, University of Louisville
Objectives: Falls are the leading cause of nonfatal unintentional injuries among hospitalized children with playground equipment accounting for over 50%. National standards for playground rung and rail design exist but there a lack of in vivo models available to test these standards. We developed a novel in vivo model to test rung and rail design. We report the feasibility and safety of the model. Methods: A device was built to simulate children hanging onto a playground bar until their hand slips off. This was defined as breakaway strength. The handle unit was mounted on a vertical cable that was mechanically raised and lowered using a linear actuator controlled by the experimenter. The unit was padded The handle unit contained a video camera that recorded the posture of the hand during each trial. Breakaway force and torque were recorded as they held onto the handle by LabView software. In addition standard anthropometrics and grip strength were recorded Results: Biomedical engineering approved the device. We recruited 397 children ranging in age from 5 – 11 years. 395/397 completed the study, 2 declined due to fear. There were no injuries and no falls. Average time to complete the study was 22 minutes. Ninety-one percent of participants were right-handed, the ethnicity was representative of the local area with 79% were Caucasian and 6% of participants were obese. Mean (± SD) height, weight and body mass index for the 397 participants were 1.28 ± 0.11m, 28.0 ± 8.12kg and 16.31 ± 2.59 kg/m2. Hand size, grip strength and maximum breakaway force, and maximum torque increased with age,. Maximum breakaway strength significantly interacted with handle size (p<0.001), age (p<0.001), female gender (p=0.0093), length (p=0.019), breath (p=0.043) and grip strength (p<0.001). Conclusion: This model is safe and feasible maybe a viable method to assess rung and rail design for playgrounds
Notes Scientific Session III-B – Jan 17, 2013 Paper 18 8:40 AM
THE DEVELOPMENT AND 1-YEAR ASSESSMENT OF A NOVEL PROTOCOL FOR REPORTING IMPAIRED DRIVERS FOR POSSIBLE DRIVERS LICENSE REVOCATION
Eric Mahoney*, MD, J. M. Kofi Abbensetts*, MD, Suresh K. Agarwal, Jr.*, MD, LISA ALLEE, MSW, PETER BURKE, MD, Tracey Dechert*, MD, Andrew Glantz*, MD, Katherine Mandell*, MD, MPH, Boston Medical Center
Presenter: Eric Mahoney, MD Discussant: Alexander Eastman, MD, Univ of Texas Southwestern Med Ctr
Objectives: To our knowledge no Level I trauma center in Massachusetts performs routine reporting of impaired drivers to the Registry of Motor Vehicles (RMV) for evaluation and possible forfeiture of drivers' licenses, often due to concern of violating HIPAA. Therefore, we developed and implemented a novel reporting protocol in collaboration with the RMV after recent state law expanded the ability of health care providers to report impaired drivers. Methods: The protocol was developed utilizing the impaired driver definition provided by the RMV and the Massachusetts Department of Public health, and included both cognitive and physical derangements caused by medical conditions and substance ingestion. HIPAA compliance was vetted through our institutional legal department and modifications were made accordingly. Drivers admitted to our facility were evaluated for impairment by the Trauma Team, and patient information was then sent via fax to the RMV for evaluation and driver notification. Results: Sixty-seven patients met criteria and were reported to the RMV over a 1-year period, representing 18% (67/380) of MVC drivers treated at our facility. Impairment was due a medical condition in 21% (14/67), and substance intoxication in 79% (53/67). Medical conditions included syncope, seizure, TIA/CVA, normal pressure hydrocephalus, dizziness and dementia. Substance ingestions included alcohol, cocaine, marijuana, heroin, benzodiazepines, methadone, prescription narcotics and muscle relaxants. This led the RMV to proceed with surrender of license in 13 drivers and request for medical clearance in 54 drivers. Conclusion: A reporting mechanism of impaired drivers was successfully implemented in our trauma center. With broad adoption by other centers, this may lead to a greater willingness to report impaired drivers. In addition, impaired driving was a frequent factor during MVC, occurring in 18% of drivers.
Notes Scientific Session III-B – Jan 17, 2013 Paper 19 9:00 AM
PILOT EVALUATION OF THE SHORT TERM EFFECT OF DRIVING SIMULATION ON NOVICE ADOLESCENT DRIVERS
Akpofure Peter Ekeh*, MD, Dustin Bayham, BS, Kyle Herman, MBA, Ronald Markert, PhD, Mary C. McCarthy*, MD, Wright State University
Presenter: Akpofure Peter Ekeh, MD Discussant: Thomas Hayward, MD, Indiana University
Objectives: Several successful initiatives over the last few decades have led to improvements in driving safety especially among adolescents. In spite of a widespread application in the aviation industry and other fields, computerized simulation has been limitedly utilized as a tool for improving driving safety. We prospectively studied a group of nascent high school drivers, subjected to comprehensive virtual driving simulation modules to identify the subsequent effects on their driving records. Methods: Forty high school students with driver's licenses that had been issued within 1year were enrolled for participation and prospectively randomized into Simulation and Control groups. The Simulation group underwent 11 modules of training on a Virtual Driving Simulator spanning a total of six hours over five days. Their driving records from the Bureau of Motor Vehicles were compared at 6 month and 1 year periods specifically looking at traffic violation and crashes. Results: A total of 16 subjects completed the Simulation training and 19 served as controls. Age and gender distribution was similar. Overall mean age was 17.4 yrs. The mean time to the initial offence was similar – Simulation (117 days) vs. Control (105 days) – p= 0.8559. At 180 days, 2/16(12.5%) in the Simulation group had a recorded driving infraction compared with 5/19(26.3%) in the Control group.(p =0.415) At 360 days, 19% of the Simulator group obtained a driving infraction vs 37% of the Control group (p=.2853) No subject in the Simulator group was involved in a car crash compared with 26% in the control group.(p =0.0493) Conclusion: This pilot evaluation of Driving Simulation demonstrated positive trends in the reduction of traffic violations and offences in novice adolescent drivers. A statistically significant reduction in the number of car crashes in individuals who had undergone Virtual Simulation was observed. Future studies are warranted to identify the potential utility of this technology in improving driving safety in teens and others. Notes Scientific Session III-B – Jan 17, 2013 Paper 20 9:20 AM
ADOLESCENT PERCEPTIONS OF DANGEROUS DRIVING FOLLOWING EXPOSURE TO MOCK CRASHES
Chris McGrath, RN, Chris Schwartz, PhD, Renae Stafford*, MD, University North Carolina
Presenter: Chris McGrath, RN Discussant: Melissa Harte, RN, MS, Phoenix Children’s Hospital
Objectives: Mock motor vehicle crashes are conducted annually at high schools in the United States. We were unable to identify any scientific literature that addresses their effectiveness to deter dangerous driving decisions. The objective of this study was to determine if mock crashes change teenagers' decision making with respect to dangerous driving over time as measured by the Dula Dangerous Driving Index (DDDI) survey instrument. Methods: Students from 3 urban and 1 rural high schools in North Carolina were given an anonymous survey that included questions from the DDDI. It was administered 1-2 weeks prior to viewing a mock crash (PRE),immediately following the mock crash event (DAY) and a final time at 180 +/-14 days post event (POST). Results: 3028 surveys (PRE 1407, DAY 1137, and POST 484) were collected with 2846 complete for data analysis. Not all of the students who completed the first survey were able to attend the mock crash and 1 of the four schools was not able to participate in the 180 day follow-up survey. Students reported texting, using cell phone while driving and driving with 2 or more friends less often immediately after viewing the mock crashes ( p< .01, <.01 and < .02, respectively). The mean DDDI (DAY 52.54) was significantly decreased from (PRE 57.04) with p = 0.029 but this effect was not sustained at 180 days. Males self identified significantly higher risk behaviors PRE than did females (Mean DDDI 59.16 vs. 54.21) and in 2 of three sub-indices of DDDI. Only the risky driving sub index remained significantly higher for males on DAY. POST data were similar to PRE with males scoring statistically higher than females in the mean DDDI and same 2 of 3 sub-indices. Conclusion: Mock crashes have an effect on self reported dangerous driving habits immediately after attending the event that is not sustained over time. Males report more dangerous driving behaviors than females. Further research should include interventions that address this difference and other strategies for sustainability. Notes Scientific Session IV-A – Jan 18, 2013 Paper 21 8:00 AM
CHARACTERIZING VASOACTIVE MEDIATOR RELEASE DURING RESUSCITATION OF TRAUMA PATIENTS
Stephen Cohn*, MD, Marc DeRosa, RT, Janet McCarthy, RN, Juquan Song, PhD, Christopher E. White*, MD, FACS, Christopher Louden, MS, Joel Michalek, PhD, University of Texas Health Sciences Center
Presenter: Stephen Cohn, MD Discussant: A. Tyler Putnam, MD, Mountain State Health Alliance
Objectives: Mortality from hemorrhagic shock after arrival to major urban trauma centers has been reported as high as 50%. We sought to perform the first characterization of vasoactive mediators release during resuscitation of hypotensive trauma patients. Methods: The IRB-approved study was conducted under waiver of consent. Adults with clinical evidence of acute traumatic injury and systolic blood pressure < 90 mmHg within 1 hour of arrival were evaluated at our Level I trauma center. 203 patients were screened with 50 enrolled from February 2010 to February 2011. Demographic information was also collected. Blood samples were obtained at 0, 30, 60, 90, 120 and 240 minutes after arrival and assays were performed for Vasopressin, Angiotensin, Epinephrine, and Cortisol. We assessed the significance of variation in these vasoactive mediators with injury with adjustment for time using repeated measures linear models in log units. Results: We found that mean vasopressin increased significantly with injury (p=0.03), while mean angiotensin (p=0.60), cortisol (p=0.73), and epinephrine (p=0.06) did not. (See Figure). Conclusion: We believe that this is the first clinical trial to serially evaluate vasoactive mediators following trauma. Vasopressin in particular and epinephrine appear to be the key mediators produced in the human response to severe injury. Deficiency of these two vasoactive substances may contribute to intractable shock states.
Mean vasopressin, angiotensin, cortisol, and epinephrine in log units by injury status (injured=ISS≥15, not injured=ISS <15) and time among 50 civilian casualties.
Notes Scientific Session IV-A – Jan 18, 2013 Paper 22 8:20 AM
PNEUMATOSIS INTESTINALIS PREDICTIVE EVALUATION SCORE (PIPES): A MULTICENTER CENTER EPIDEMIOLOGIC STUDY
Joseph J. DuBose*, MD, Carlos Brown, MD, Michael Esparza, BS, Paula Ferrada*, MD, Kenji Inaba, MD, Steven B. Johnson*, MD, Matthew E. Lissauer*, MD, Xian Luo-Owen, MD, PhD, Adrian A Maung*, MD, Thomas O'Callaghan, MD, Obi Okoye, MD MRCSI, Thomas M. Scalea*, MD, FACS, FCCM, Alison M. Wilson*, MD, University of Maryland / R Adams Cowley Shock Trauma Center
Presenter: Joseph J. DuBose, MD Discussant: Jill Watras, MD, Henry Ford Health System
Objectives: Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life-threatening. To date, all series of PI outcomes consist of case reports and small retrospective series. Methods: We conducted a retrospective multicenter study, involving 8 centers who identified patients with PI from January 2001 to December 2010. Demographics, past medical history, clinical presentation and outcomes were collected. The primary outcome was the presence of pathologic PI defined as confirmed by transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression was utilized to identify independent predictors for pathologic PI and to develop a regression tree (CART) to generate a clinical prediction rule for pathologic pneumatosis intestinalis. Results: During the 10-year study period, 500 patients with PI were idenitified. Of this number, 299 (60%) had benign disease and the remaining 201 (40%) had pathologic PI. A wide variety of exam findings, conditions, laboratory values and imaging findings were statistically significant predictors of pathologic PI on univariate comparison, including peritonitis, steroid and antibiotic use, renal failure and hyperlactemia. In the regression model, a lactate ≥ 2.0 was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation and absent bowel sounds also demonstrating significance in the model. CART analysis using variables from the regression was used to create a clinical prediction rule. In this tree, the presence of a lactate value ≥ 2.0 and hypotension/vasopressor use had a predictive probability of 93.2%. Conclusion: Discerning the clinical significance of PI remains a challenge of modern medical care. We identified the independent predictors of PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.
Notes Scientific Session IV-A – Jan 18, 2013 Paper 23 8:40 AM
MITOCHONDRIAL DAMPS RELEASED BY ABDOMINAL TRAUMA SUPPRESS PULMONARY IMMUNE RESPONSES
Carl J. Hauser*, MD, Cong Zhao, PhD, Alok Gupta*, MD, Stephen R. Odom*, MD, Kiyoshi Itagaki, PhD, Harvard Medical School
Presenter: Carl J. Hauser, MD Discussant: Jose Pascual Lopez, MD, University of Pennsylvania
Objectives: Historically, fever, pneumonia and sepsis after chest trauma is ascribed to pain, splinting and poor pulmonary toilet. But no evidence supports those assertions and no biologic mechanisms have been advanced to explain these associations. Our studies have shown injured tissues release mitochondrial debris that attracts neutrophils (PMN). Thus we hypothesized mitochondria (MT) released by injured, dying tissue could divert neutrophils from the lung, leaving it susceptible to bacterial invasion. Methods: Anesthetized rats (6-10/group) underwent chest percussion to induce pulmonary contusion (PC). To model MT release from liver injury, some rats had sonicated MT isolated from rat liver (equivalent to MT from 5% liver necrosis) injected into the peritoneal cavity. At 16h bronchoalveolar and peritoneal lavages were performed. Lavage fluids (BALF, PLF) were assayed for PMN count, albumin, IL-β and CINC. Results: PC caused a 50-fold increase in BALF neutrophils (Fig 1) and tripled lung albumin leak (Fig 2). Peritoneal MT had no direct effect on lung PMN or leak, but increased peritoneal IL-β and caused marked influx of PMN and albumin into the peritoneum. In rats undergoing PC, additional injection of MT into the peritoneum markedly decreased BALF PMNs (P<0.001, Fig 1) and albumin leak (P<0.002, Fig 2). Conclusion: Rather than acting as a 'second hit' to induce PMN-mediated lung injury, MT debris acts as a chemoattractant, diverting PMN away from lung injury to systemic sites of injury. This may diminish acute lung injury but it is expected to make the lung susceptible to infection. This novel paradigm provides a direct mechanistic model of the relationship between systemic blunt tissue injury, pneumonia and sepsis that can now be studied and used to improve care and trauma outcomes.
Notes Scientific Session IV-A – Jan 18, 2013 Paper 24 9:00 AM
A PROTOCOL-DRIVEN APPROACH TO SCHEDULING EMERGENT CHOLECYSTECTOMY DECREASES HOSPITAL LOS WHILE MAINTAINING QUALITY
Stancie Rhodes*, MD, Hannah Xu, B.S., Joshua M. Bershad, MD, Vicente H. Gracias*, MD, Robert Wood Johnson Medical School
Presenter: Stancie Rhodes, MD Discussant: John Santaniello, Loyola University Medical Center
Objectives: In April 2011, the Division of Acute Care Surgery began scheduling its cholecystectomies as "Class 3 Emergency" cases, requiring operation within 6 hours. We hypothesize that a protocol-driven approach to classing cholecystectomy as an emergency operation significantly reduces the hospital length of stay (LOS), translating to significant healthcare savings. Methods: We retrospectively collected data on all patients (DRG 414-419) discharged by the ACS service for 11 months before (Group A) and 11 months following (Group B) implementation of the classing policy. Information regarding group-specific outcomes and expenditures came from the hospital's Crimson Database©. We compared this to data on patients operated on by all members of the Department of Surgery during those time periods (Group C-prior to classing and Group D-after classing). Results: Cholecystectomy was performed on 183 patients by 7 ACS surgeons over a 22 month period. No significant differences in demographics, severity of illness, or clinical outcomes were found between Groups A – D. The mean length of stay (LOS) for the 106 patients in Group A was similar to that of Group C (3.29 vs 3.26, NS), while LOS for the 77 patients in Group B was significantly less than Group D (2.81 vs 3.46, p < .05). This translates to a .6 day decrease in our LOS and a $459/case cost savings. Using the 2010 NJ State Statistics for DRGs 414-419 compiled by the AHRQ, we estimate that this translates to an annual cost savings of $5,315,679 in the state of New Jersey. Conclusion: A classing policy for rapid operation reduces LOS for emergent cholecystectomy. If a similar classing policy were adopted by New Jersey, the state would save over $5 million per year. This represents a significant reduction in healthcare expenditures while maintaining quality of care.
Notes Scientific Session IV-A – Jan 18, 2013 Paper 25 9:20 AM
HOSPITAL BASED TRAUMA QUALITY IMPROVEMENT INITIATIVES: FIRST STEP TOWARDS IMPROVING TRAUMA OUTCOMES IN THE DEVELOPING WORLD
Hasnain Zafar, MBBS, FRCS, Zain Ghani Hashmi, MBBS, Nabeel Zafar, MBBS, MPH, Mehreen Kisat, MBBS, Asad Moosa, MBBS, Farjad Siddiqui, MBBS, Amyn Pardhan, MBBS, Asad Latif, M.D.,MPH, Adil H Haider*, MD, MPH, Department of Surgery, Aga Khan University Hospital
Presenter: Hasnain Zafar, MBBS, FRCS Discussant: Mark Seamon, MD, Cooper University Hospital
Objectives: Injuries remain a leading cause of death in the developing world. Whereas new investments are welcome, Quality Improvement (QI) at the currently available trauma care facilities is essential. The objective of this study is to determine the effect, and long term sustainability of trauma QI initiatives on in-hospital mortality and complications at a large tertiary hospital in a developing country. Methods: In 2002, a specialized trauma team was formed (members trained using ATLS), and a western style trauma program established including a registry and quality assurance program. Patients from 1998 onwards were entered in to this registry, enabling a pre and post implementation study. Adults (≥16 yrs) with blunt or penetrating trauma were analyzed. The main outcomes of interest were 1) in-hospital mortality and 2) occurrence of any complication (see table). Multiple logistic regression was performed to assess the impact of formalized trauma care on outcomes, controlling for covariates reaching significance in the bivariate analyses. Results: A total of 1,227 patient records were analyzed. Patient demographics and injury characteristics are described in Table 1. Overall in-hospital mortality rate was 6.5% and complication rate was 11.1%. Upon multivariate analysis, patients admitted during the trauma service years were 3 times less likely to die (95% CI= 1.22, 7.69) and 1.1 times (95% CI = 1.04, 1.22) less likely to have a complication than those treated in the pre-trauma service years. Conclusion: Despite significant delays in hospital transit and lack of pre-hospital trauma care, hospital level implementation of trauma QI program greatly decreases mortality and complication rates in the developing world.
Notes Scientific Session IV-A – Jan 18, 2013 Paper 26 9:40 AM
THE MITOCHONDRIAL MEMBRANE POTENTIAL DECREASES IN PERIPHERAL BLOOD MONOUCLEAR CELLS ALONG WITH THE INCREASE IN LACTATE LEVELS IN HYPOVOLEMIC SHOCK IN RATS
José Paul Perales Villarroel, M.D., Evan Werlin, BS Yuxia Guan, B.S., Mary Selak, PhD, Lance B. Becker, MD, Carrie A. Sims*, MD, MS, Hospital of the University of Pennsylvania, Trauma Division
Presenter: José Paul Perales Villarroel, MD Discussant: Randall Friese, MD, University of Arizona
Objectives: The aim of this study was to investigate the mitochondrial integrity of peripheral blood mononuclear cells (PBMC) and its relationship with serum lactate levels in a hypovolemic shock model in rats. Methods: In this experimental design, using a experimental hemorrhagic shock model where the subjects were bled to a mean arterial pressure (MAP) of 40 mmHg, 19 Long-Evans rats were distributed in four groups: 1) Sham, 2) maximum bleeding out time (MBOT) that represents physiologic decompensation and loss of vasomotor tone, 3) 40%SVT, where MAP of 40 mmHg was maintained by incrementally infusing 40% of the shed blood volume in Lactated Ringer's (LR) and 4) 60R, where animals were resuscitated with 4 times the total shed volume in LR over 60 minutes (60R) and maintained a blood pressure of 40 mmHg. Blood samples were taken from the femoral artery and PBMC were isolated for flow cytometry (FACS) analysis. Also, lactate levels, oxygen saturation, bicarbonate (HCO3), glucose, blood ureic nitrogen (BUN) and electrolytes were assessed. The mitochondrial content, mitochondrial membrane potential and reactive oxygen species (ROS) were assessed using Mito Tracker green, Tetramethylrhodamine (TMRE) and Mitosox Red , respectively, using FACS. Results: Data showed a dramatic decrease in the membrane potential in MBOT (p value=0.032) and 60R group (p=0.017) (Figure 1), as well as a markedly increase in lactate levels for the same groups (p=0) (Figure 2). The production of ROS was significantly higher in the MBOT group (p value=0.025). Conclusion: Decrease in the mitochondrial membrane potential in PBMC might be associated with the gradual increase in lactate levels in hypovolemic shock, in rats. There is an increase in ROS production under the same conditions.
Notes Scientific Session IV-B – Jan 18, 2013 Paper 27 8:00 AM
MULTIDISCIPLINARY ACUTE CARE RESEARCH ORGANIZATION (MACRO): IF YOU BUILD IT THEY WILL COME
Barbara Early, BS, David Huang, MD, Clifton Callaway, MD, Mazen Zenati, MD, Derek Angus, MD, Scott Gunn, MD, Donald Yealy, MD, Daniel Unikel, BS, Timothy Billiar, MD, Andrew B. Peitzman*, MD, Jason L. Sperry*, MD, MPH, University of Pittsburgh
Presenter: Barbara Early, BS Discussant: Jeffrey Claridge, MD, MetroHealth Medical Center
Objectives: Clinical research will increasingly play a core role in the evolution and growth of acute care surgery (ACS) program development. Effective clinical research infrastructure in the current academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO). Methods: In 2008, to minimize redundancy, cost, and maximize existing resources promoting acute care research, MACRO was created unifying clinical research infrastucture between the Departments of Critical Care Medicine, Emergency Medicine and Surgery. MACRO provides clinical study feasibility evaluation, regulatory submission and compliance, study set-up and execution, data entry, sample processing and storage. Over the time periods 2008-2011 we determined volume of clinical studies, patient enrollment for both observational (OBS) and interventional (INTV) trials, and staff growth since MACROs origination. Results: From 2008 to 2011, the volume of patients enrolled in clinical studies which MACRO facilitates has significantly increased over 300% (Fig, '+'). The % of INTV/OBS trials has remained stable over the same time period (50-60%). Staff has increased from 6 coordinators to 10 with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient and additional outside departments now seek MACROs services. Over 65 principal investigators and co-investigators from 8 different departments currently utilize MACRO services (2012 data). Conclusion: Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other ACS programs.
Notes Scientific Session IV-B – Jan 18, 2013 Paper 28 8:20 AM
THE IMPACT OF IMPLEMENTING A 24/7 OPEN TRAUMA BED PROTOCOL IN THE SURGICAL INTENSIVE CARE UNIT ON THROUGHPUT AND OUTCOMES
Akash Bhakta*, BS, Matthew Bloom, MD, Heather Warren, MD, Nirvi Shah, BS, Tamara Casas, BS, Tyler Ewing, BS, Marko Bukur, MD, Rex Chung, MD, Eric Ley, MD, Ali Salim*, MD, Daniel Margulies, MD, Darren Malinoski, MD, Cedars-Sinai Medical Center
Presenter: Akash Bhakta, BS Discussant: Amy McDonald, MD, MetroHealth Medical Center
Objectives: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010, we implemented a 24/7 open trauma bed protocol in our two surgical intensive care units (SICU) in order to facilitate rapid admission from the ED. This required the maintenance of a daily bump list and timely transferring of patients out of the SICU. We hypothesized that ED LOS and mortality would decrease after implementation. Methods: The following data from patients admitted directly from ED to the ICU were retrospectively compared before (2009) and after (2011) implementation of a trauma bed protocol at a level-I trauma center: age, gender, GCS, shock on admission (SBP<90 mmHg), mechanism of injury, injury severity scores (ISS and AIS), ED LOS, ICU re-admission rates, and mortality. Results: 267 of 1611 (17%) patients before and 262 of 1266 (21%, p<0.01) patients after the protocol were admitted directly to the ICU, despite similar characteristics. Overall, ED LOS decreased from 4.2 ± 4.0 hrs to 3.1 ± 2.1 hrs (p=.01). Mortality was unchanged for all patients (9% vs. 8%, p=0.56), but mortality and ED LOS were lower after protocol implementation in patients with an ISS≥25 (30% vs. 13%, p=0.04 and 3.1 ± 2.5 vs. 2.2 ± 1.6, p<0.05) and in patients with a with a Head AIS≥3 (12% vs. 6%, p=0.04 and 4.2 ± 4.9 vs. 3.1 ± 2.0, p=0.01). A greater proportion of Head AIS≥3 patients were admitted to a designated surgical ICU after the protocol (88% vs 97%, p<0.01). ICU readmission rates were unchanged (0.3% vs. 1.5%, p=0.2). Conclusion: The implementation of a 24/7 open trauma bed protocol in the SICU was associated with a decreased ED LOS in all patients and lower mortality rates in the most severely injured patients. Improved throughput was achieved without an increase in unplanned readmissions to the SICU.
Notes Scientific Session IV-B – Jan 18, 2013 Paper 29 8:40 AM
A REVISED PRE-HOSPITAL TRAUMA TRIAGE PROTOCOL: SAVING PATIENTS AND RESOURCES
Katherine B Kelly, MD, Aman Banerjee, MD, Michael Nowak, PhD, Patricia A Wilczewski, RN, Deborah Allen, BSN, Jeffrey A. Claridge*, MD, MS, MetroHealth Medical Center
Presenter: Katherine B Kelly, MD Discussant: Tanya Zakrison, Miller School of Medicine, Univ of Miami
Objectives: To create a revised pre-hospital trauma triage protocol that could identify a subset of trauma victims that can be safely treated at a local emergency department (ED). Methods: A revised emergency medical services (EMS) trauma triage protocol checklist was devised which divided patients into Red, Yellow, or Green groups. Red included those most likely to be severely injured while Green had those unlikely to be seriously injured. Changes included decreasing Glasgow Coma Scale score from less than or equal to 13 to <12. The presence of abdominal tenderness, distension, or seat belt sign and speed of a motor vehicle crash were removed. Age requiring a trauma center was increased from 55 to 70. For 3 months in 2011, EMS completed a revised triage checklist for each trauma while continuing to use current triage rules. Revised over and under triage rates were calculated. Green patients requiring ICU or OR admission had their charts reviewed to determine protocol failure or coding error. Results: There were 614 patients transported by EMS to 3 trauma centers. EMS designated 143(23%) Red, 299 (49%) Yellow, and 172 (28%) Green patients. 510 (83%) of the patients were transported to the Level I center. Level II West received 37 (6%) patients and Level II East received 67 (11%) patients. Of these, 28% of all EMS transports were Green and could be taken to the nearest ED under the revised protocol. There was no mortality in the Green group. There were 7 Green patients who required admission to the ICU or OR. Of these, 2 patients had injuries from falls between 10 and 20 feet. Coding errors were found in 4 of the cases. Correcting for coding errors resulted in an under-triage rate of 1%. Conclusion: Current trauma triage rules result in inefficient use of trauma center resources by patients with minor injuries. Use of a revised triage protocol could potentially transport patients with minor injuries to a non- trauma hospital ED. Notes Scientific Session IV-B – Jan 18, 2013 Paper 30 9:00 AM
FACTORS ASSOCIATED WITH HIGHER PATIENT SATISFACTION SCORES FOR PHYSICIAN CARE: WHAT DOES A "SATISFIED" TRAUMA PATIENT LOOK LIKE?
Frederick Rogers*, MD, Jeffrey Anderson, MD, Matthew Edavettal, MD, PhD, Michael Horst, PhD, Turner Osler, MD, Tuc To, BS, Daniel Wu*, DO, Lancaster General Hospital
Presenter: Frederick Rogers, MD Discussant: Thomas Esposito, MD, Loyola University Medical Center
Objectives: We hypothesized that specifically lower socioeconomic status and higher injury severity scores (ISS) would lead to lower Press-Ganey (PG) survey scores. Methods: PG physician satisfaction scores for September 2004 to December 2010 were compared to multiple trauma variables and the association of a mean physician score greater than 75 (surveys are sent out to 100% of discharged inpatients, scores range from 0-100 and based on five specific questions related to the care provided by the surgeon). Those variables which proved significant on univariate analysis were then subjected to multivariate logistic regression analysis. Significance was at p<0.05. Variables analyzed included: age, gender, ISS, trauma level, mechanism of injury, length of stay, vent days, trauma surgery, occurrences, pre-existing conditions, Amish, payor status, geographic location, ethnic diversity, and SES. Results: 1,631 trauma patients (13.4%) returned PG questionnaires out of 12,196 trauma admissions. Patients aged 0-17 and >64 were 1.88 and 2.19 times more likely to give a mean physician score of 75 or higher than the reference. Patients requiring surgery were 1.54 times more likely to give a mean physician score higher than 75 than patients that did not. Patients with a commercial payor status were 1.78 times more likely to give a mean physician score of 75 or higher than the reference payor group. Conclusion: The profile of a satisfied trauma patient is one that is >64 years old (or < 18 years old), has commercial insurance and requires surgery. ISS and SES were not significantly related to physician satisfaction ratings in trauma patients as hypothesized. Understanding the specific characteristics of PG results for trauma patients will allow surgeons and their hospital partners to develop strategies to improve patients' satisfaction with their trauma surgeon's care.
Notes Scientific Session IV-B – Jan 18, 2013 Paper 31 9:20 AM
DEDICATED SURGICAL CRITICAL CARE SERVICE LINE OFFERS OPPORTUNITY FOR ENHANCED REVENUE AND ADVANCED PRACTITIONER DEVELOPMENT
Brian K. Jefferson, ACNP, Martha Griffo, CPC, John M. Green*, MD, William S. Miles*, MD, Ronald F. Sing*, DO, Michael H. Thomason*, MD, A. Britton Christmas*, MD, FACS, Carolinas Medical Center
Presenter: Brian K. Jefferson, ACNP Discussant: William Hoff, MD, St. Luke’s Hospital
Objectives: While national organizations promote the integration of emergency general surgery for trauma surgeons, the addition of surgical critical care services provides a means to stimulate a challenging practice and to improve procedural productivity for advanced practitioners. We undertook this study to assess the growth of a dedicated surgical critical service line at a Level I trauma center. Methods: A surgical critical care consult service was established in 2006 staffed by 8 trauma/critical care surgeons (TS) in conjunction with six advanced practitioners (AP). Initially, daily rounds were conducted by a single TS and AP. Prospective data was collected for consults, procedures, daily census, ICU length of stay (LOS), and physician charges from 2008-2011. A single TS and 3 AP's were added during the study period. At present, daily rounds are conducted by a TS in conjunction with 2 AP's. Results: A dedicated surgical critical care service line yielded 3517 consults (2008–385, 2009–767, 2010–1051, 2011–1314). In addition, 91 organ donors were managed during the course of the study. Average daily census increased from 8.6±1.7 in 2008 to 19.5±2.6 in 2011. Of note, mean ICU LOS decreased from 5.7±1.3 days in 2008 to 4.7±5 days in 2011. From a financial perspective, the development of a dedicated surgical critical care service line generated physician charges of $13,874,149 (2008-$1,785,819, 2009-$2,663,976, 2010-$3,297,330, 2011-$6,127,024). Furthermore, this service line afforded ample procedural opportunities for advanced practitioners and attending physicians. Advanced practitioners assisted with more than 1570 procedures during the 4 year period (460 tracheostomies, 471 bronchoscopies, 393 central lines, 192 PEG placements, and 54 vena cava filter placements). Conclusion: The creation of a surgical critical care service line provides an invaluable hospital service with the potential to generate substantial revenue while increasing the procedural opportunities for trauma surgical intensivists and AP's.
Notes Scientific Session IV-B – Jan 18, 2013 Paper 32 9:40 AM
BORROWING BEST PRACTICES FROM TRAUMA: AN ACUTE CARE SURGERY REGISTRY AND PI PROGRAM
Patrick K. Kim*, MD, Benjamin M. Braslow*, MD, Sue Auerbach, MHA, RHIA, Kristen Chreiman, BSN, Janet McMaster, RN, MHSA, Sean Cosgriff, BA, Patrick M. Reilly*, MD, Hospital of the University of Pennsylvania
Presenter: Patrick K. Kim, MD Discussant: Preston Miller, III, MD, Wake Forest School of Medicine
Objectives: A dedicated registry and performance improvement (PI) program is integral to trauma care. Hypothesizing that an analogous process may benefit Acute Care Surgery (ACS) patients, we implemented a dedicated ACS registry and PI program. Methods: This retrospective study evaluated ACS activity at a level I trauma center from 6/11 to 6/12. The ACS registry, designed with a database vendor, captured patient demographics, comorbidities, diagnoses, procedures, user-defined audit filters, and PI occurrences. It was maintained by divisional administrative and PI staff. Trauma registry and PI activity were separate. Impact of ACS involvement on mortality was evaluated by Fisher's exact test; p<0.05 was significant. A subset of ACS deaths was subject to focused peer review. PI determinations were compared to University HealthSystem Consortium (UHC) relative expected mortality (REM). Results: ACS evaluated 1470 patients (48% ED, 40% in-house, 9% transfer, 3% other); 60% had abdominal complaints. Overall mortality was 124/1470 (8.4%). Of 778 (53%) with complete registry data, ACS intervened surgically in 387 (49.7%). Mortality with active ACS involvement was 51/1470 (3.5%) (p<0.001). Focused review of 30 deaths identified 112 PI occurrences. Opportunities for improvement were present in 5/30 (16.7%): 2 delays to OR, 2 technical issues, and 1 judgment issue. Of 24/30 deaths with UHC valuation, 20 were "above" or "well above" REM and 4 were "below" REM. Conclusion: Half of patients evaluated by ACS underwent surgery. Active ACS involvement was associated with improved survival. Internal PI review had high concordance with external risk-adjusted mortality benchmarking. Although potentially resource-intensive, a dedicated registry and PI process may improve outcomes of ACS patients. Notes Poster 01
ADRENOMEDULLIN LEVELS CORRELATE WITH RATES OF SEPSIS, MULTI-ORGAN SYSTEM FAILURE AND MORTALITY, INDEPENDENTLY OF PERCENT TOTAL BODY SURFACE AREA BURNED IN BURN PATIENTS
Rafael F. Diaz-Flores, MD, MPH, Fernando A Rivera-Chavez, MD, Francis R. Ali- Osman, MD, Joseph P. Minei*, MD, FACS, Steven E. Wolf*, MD, Ming-Mei Liu, MS, Christian T. Minshall*, MD, PhD, University of Texas Southwestern Medical Center
Objectives: Adrenomedullin (ADM) is an endothelial-derived protein that modulates cardiac contractility in response to injury and shock states. Burn patients have a physiologic response that is dependent on the degree of injury and are high risk for multi-organ failure (MOF), sepsis and death. Our objective is to characterize the ADM reponse in burn patients and its association with these outcomes. Methods: An enzyme linked immunoabsorbent assay (ELISA) was used to measure serum ADM (ng/ml) in samples drawn from 24 burn patients stratified by percentage of total body surface area (TBSA, group A: <15, group B: 16-30, group C: > 60) on post-injury days 1,3,7 and 14. Data were analyzed using Mann-Whitney test; statistical differences were defined as p<0.05. Results: ADM levels were significantly higher on days 1 and 3 in groups B and C as compared to group A. There were no differences between groups on days 7 or 14. Patients with sepsis, MOF or that died had significantly higher levels at all times independent of %TBSA burned (see graph, MOF not shown). Conclusion: ADM levels correlate with high degree of injury in burn patients. These levels remain elevated in patients with sepsis, MOF and mortality independent of %TBSA burned. Further studies are needed to better understand the role of ADM in response to injury, as well as the potential for its therapeutic use in resuscitation.
Notes
Poster 02
PENETRATING VIOLENCE: A CALL FOR PREVENTION
Joan M. Pirrung*, RN, MSN, ACNS-BS, Pamela Woods*, RN, ACNS-BC, CEN, Michael Kalina*, DO, Kathleen Boyer, BSN, RN, CCRN, Mark D. Cipolle*, MD, PhD, Christiana Care Health System-Christiana Hospital
Objectives: Violence is a major public health issue in the US and an alarmingly new concern in a suburban trauma center. In 2009, the city's violent crime rate average was higher than the national average and has one of the highest crime rates per capita nationally. Over a 10 year period, the trauma center's registry catalogued an increase in gun shootings by 62%. Therefore, injury prevention efforts are focused in high-risk violent crime areas. The initial effort was to create a short film depicting real life situations known to glorify gang membership along with medical and legal consequences related to gun violence. Methods: In partnership with the US Attorney 's Office, a local film production company, city officials and trauma center clinicians, a short film was written and produced. The film is part of a violence prevention program presented in the following format: 1) view the short film, 2) lecture by a US Attorney representative on the legal consequences of violent activities and 3) lecture by a trauma clinician on physical injuries and emotional harm associated with gun violence. Results: Since the premier of the violence prevention program in October of 2011, 56 programs have been conducted reaching 2000 at-risk youths, young adults and parents. Eight hundred and forty eight post-program surveys were distributed with 603 (71.1%) returned. Of those who returned the survey: 1) 97.8% responded that the film and presentation provided information influencing positive choices to avoid gun and gang violence, 2) 95.2% felt that they increased their knowledge regarding negative consequences associated with gang membership, and 3) 91.9% responded that they would recommend the film and presentation. Conclusion: There has been overwhelmingly positive feedback on the content of the short film and associated presentations. Future plans are to develop a documentary including live footage in the trauma bay with interviews from medical experts and gang members on the impact of violence in the communities.
Notes
Poster 03
MORTALITY INCREASES WITH REPEATED EPISODES OF NON-ACCIDENTAL TRAUMA IN CHILDREN
Katherine Deans, MD, MHSc, Johanna R Askegard-Giesmann, MD, Jonathan I. Groner*, MD, Jonathan Thackeray, MD, Peter C Minneci, MD, MHSc, Nationwide Children's Hospital
Objectives: Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury. The objective of this study was to assess the mortality risk in children who are victims of repeated episodes of NAT. Methods: Using the Ohio State Trauma Registry, we identified the records of all patients <16 years of age hospitalized between 2000-2010 with an ICD-9 code for NAT. Potential victims of repeated episodes of NAT were identified by using data matches between records within the registry for all of the following elements: date of birth, race, and gender. We subsequently applied temporal sequencing to eliminate records where death occurred prior to the second record. Statistical comparisons were made using Fisher's exact and Wilcoxon rank sum tests. Results: 1,572 victims of NAT were identified with 53 patients meeting criteria for repeated episodes of NAT. Compared to patients with a single episode of NAT, patients with repeated episodes of NAT were more likely to be male (66% vs. 52%, p=0.05), white (83% vs. 65%, p=0.03), evaluated at a pediatric trauma center (87% vs. 70%, p=0.008), and were more likely to die (24.5% vs. 9.9%, p=0.002). Within the group of children who suffered repeated NAT, black patients were more likely to die (57% vs. 20%, p=0.05). Patients who died with repeated episodes of NAT had a longer interval from initial episode to second episode (median (IQR): 527 days (83-1099) vs. 166 days (52-502), p=0.07) and were older during their second episode of NAT (1 year (0-3) vs. 0 years (0-1, p=0.05). At initial presentation, lower extremity fractures (p=0.09) and liver injuries (p=0.06) were reported more commonly in non-survivors of repeated episodes of NAT. Conclusion: Mortality is significantly higher in children who suffer repeated episodes of NAT. Therefore, it is critically important to accurately identify a child's initial episode of NAT. Subsequently, appropriate resources and follow-up should be provided to these children to prevent future catastrophic episodes of NAT.
Notes Poster 04
ENDOTRACHEAL TUBE REPOSITIONING: HOW ACCURATE?
Ming-Li Wang, MD, Kevin M. Schuster*, MD, Bishwajit Bhattacharya*, MD, Adrian A Maung*, MD, Lewis J. Kaplan*, MD, FACS, FCCM, FCCP, Kimberly A. Davis*, MD, Yale University School of Medicine
Objectives: Sub-optimal positioning of endotracheal tubes (ETs) is often identified on routine chest radiographs prompting adjustment. The accuracy of ET adjustments based on tube measurement markings at the incisors has not been reported. Methods: We performed a one-year prospective observational study of all surgical ICU patients requiring repositioning of their ET based on chest x-ray (CXR). The ET was repositioned by a respiratory therapist using tube markings at the incisors and follow up CXRs were obtained within 2 hours. CXR tube locations were compared to the planned intervention. Mean, median, interquartile range (IQR) and chi-square results are reported. Results: Fifty five patients met inclusion criteria and had a complete set of data (80% male). The most common sub-optimal positioning was an ET requiring advancement (80%). Patients requiring ET withdrawal were more likely female (8/11, p<0.001). The mean difference between the planned and actual intervention was 1.55cm (95% CI 1.16cm – 1.95cm) achieving a mean of 40% of the planned intervention (95% CI 29.0% - 51.0%). For advancement the median starting position was 7.10cm (IQR 2.20cm) from the carina with a median planned advancement of 2.00cm. The actual advancement was a median of 1.15cm, achieving 57.5% of the goal. For the withdrawal group the median starting position was 0.70cm (IQR 1.05cm) from the carina with a planned median withdrawal of 2.00cm (IQR 0.75cm). The actual withdrawal was a median of 1.00cm, achieving 50.0% of the goal. There was no correlation between the original location or the planned intervention and the accuracy of the intervention (figure). In three cases the ET moved opposite of the planned intervention. Conclusion: ET re-positioning based on measurement at the incisors is inaccurate. Magnitude of the intervention did not correlate with the degree of inaccuracy. Blind repositioning of ETs should be abandoned or follow up CXRs obtained.
Notes
Poster 05
THE ECONOMIC IMPACT OF INTENSIVIST FELLOWSHIP TRAINING
Jeffrey Carter, MD, Daryhl L. Johnson, II*, MD, MPH, Renae Stafford*, MD, Preston B. Rich*, MD University of North Carolina
Objectives: Rising medical student debt and changes in physician reimbursement patterns are requiring residents to carefully examine their return on investment (ROI) for fellowship training. At the same time, there is a growing shortage of intensivists, especially surgical intensivists which are evolving into acute care surgeons. Our goal was to analyze the ROI of intensivist fellowship training in private and academic practice. Methods: Using survey data from the Association of American Medical Colleges and the Medical Group Management Association, we calculated the ROI of acute care surgery, pediatric, and medical intensivists in today's dollars. Our financial analysis incorporated average medical debt, annual income, and federal income tax into a net present value (NPV) calculation at a 5% discount rate with career duration from internship to retirement at age 65. Relative career value was defined as the ratio of intensivist to generalist NPV. Results: Over 17,000 specialty specific responses were included in the analysis. Private practice physicians had a relative career value (RCV) 15-66% higher than their academic counterparts. Academic acute care surgeons and medical intensivists decreased their RCV by 5% and 3% respectively compared to academic general surgeons and medical internists. Academic pediatric intensivists increased their RCV by 20% compared to academic pediatricians. Private practice acute care surgeons increased their RCV by 7% compared to their private practice general surgeons but remained below average for fellowship-trained surgeons. Conclusion: Academicians have lower relative career values when compared to private practitioners. Academic acute care surgeons have the lowest relative career value, which calls into question the ROI and future recruitment into the specialty. Resolving the intensivist shortage will require further analysis of the financial implications of critical care training when compared to alternative career paths.
Notes Poster 06
DEATH BY NUMBERS: HOW DO TQIP AND UHC COMPARE?
Lillian S Kao, MD, MS, Miriam Morales, MS, Avery B. Nathens*, MD, PhD, MPH, Edmund P Dipasupil, CSTR, CAISS, Sheila Lopez, RN, BSN, MA, Toni von Wenckstern, RN, MS, John B. Holcomb*, MD, Rosemary Kozar, MD, PhD, University of Texas Health Science Center at Houston
Objectives: The Trauma Quality Improvement Program (TQIP) and the University HealthSystem Consortium (UHC) provide risk-adjusted mortality rates to participating hospitals. TQIP includes a more severely ill subset of trauma patients (ISS≥9) than UHC and is considered the gold standard for trauma quality improvement and benchmarking. The two programs calculate their mortality models based on different components. We hypothesized that TQIP would more accurately predict mortality. Methods: Patients who were admitted to a Level I trauma center in 2009 and were in both the TQIP and UHC databases were included. Goodness-of-fit tests (p<0.05 indicates the model does not fit the data) and areas under the receiver operating characteristic (ROC) curves were performed for the two models for mortality. Agreement between expected mortality rates were examined using the Bland-Altman method (Stata SE v12). Results: Of 2753 TQIP patients, 2490 patients were in the UHC database. The p-values for the goodness-of-fit tests were not significant. There was no difference in the area under the ROC curves for mortality − 94.1% for TQIP and 93.6% for UHC (p=0.87). As assessed using the Bland-Altman method (FIgure), agreement was excellent when predicted probability of death was either low (<20%) or high (>70%). Conclusion: Both UHC and TQIP models predicted mortality with similarly high accuracy. However, there are differences in a small proportion of patients whose outcomes might be most amenable to intervention. These differences might be explained by different model characteristics or, alternatively, by unique attributes of specific patient populations. As these differences occur in a population where outcomes might be modifiable, it is critically important to understand the limits of quality improvement programs based on external benchmarking approaches.
Notes Poster 07
ADHERENCE TO PRBC TRANSFUSION TRIGGER GUIDELINES IS IMPROVED WITH ELECTRONIC CLINICAL DECISION SUPPORT
Rachael Callcut*, MD, MSPH, L. Tim Goodnough, MD, Steven Philips, BS, Paul Maggio, MD, MBA, Stanford University
Objectives: Despite evidence based guidelines supporting a restrictive transfusion strategy in hemodynamically stable critically ill patients, physician practice remains variable. Traditionally, educational initiatives have been employed to improve compliance, however, the improvements are modest. In contrast, electronic real-time clinical decision support (CDS) has not been previously studied and may provide additional benefit for reduction of unnecessary packed red blood cell transfusion (PRBC). Methods: A prospective, cohort of all med-surg ICU patients was followed from September 2008 to August 2011 and in hospital transfusion data was collected. All hemodynamically stable, non-hemorrhaging ICU patients were included in this analysis. An educational initiative was introduced in fiscal year 2010 and a CDS alert in 2011. Physician were notified via the computerized order entry CDS alert if the PRBC transfusion was outside of hospital guidelines. Compliance to trigger guidelines was compared in the pre-intervention (PI) vs. the educational (EDUC) initiative vs. CDS alert year. Results: Compliance with PRBC trigger guidelines improved with the greatest benefit seen after introduction of the real-time CDS alert (PI 48%, EDUC 52%, CDS 69%, p<0.0001, FIGURE) . The mean (+/- SEM) pre-transfusion hemoglobin was unchanged after introduction of the educational initiative (baseline 8.3 +/- 0.1 g/dL vs. 8.2 +/- 0.1, p=NS), however, there was a significant decrease with the CDS alert (mean 7.6 +/- 0.1, p<0.0001). Transfusions per ICU day at risk also markedly decreased with the CDS alert compared with the PI and EDUC years (PI 9.8%, EDUC 8.9%, CDS 5.9%, p<0.0001). There was no change in mortality or case mix index during the study. Conclusion: Implementation of real-time CDS improves compliance with evidence based transfusion trigger guidelines for critically ill patients.
Notes Poster 08
OUTCOMES OF PRE-HOSPITAL VERSUS IN-HOSPITAL INTUBATION IN TRAUMA PATIENTS - DOES LOCATION MATTER?
Christopher Stephens, MD, Jay Menaker*, MD, Jeffrey Glaser, MSII, Nicholas T Tarmey, FRCA, Daniel Mayer, BS, Mary E Kramer, RN, Deborah M. Stein*, MD, Thomas M. Scalea*, MD, FACS, FCCM, University of Maryland School of Medicine - R Adams Cowley Shock Trauma Center
Objectives: Controversy exists on the association of outcome after injury when comparing in-hospital versus pre-hospital intubation. The purpose of this study was to evaluate outcomes based on location of intubation. Methods: Over a 9-month period, patients intubated in the field (FI) or within 60 minutes of arrival to the trauma center (TCI) were prospectively enrolled. Patients with cardiac arrest or those transferred were excluded. Demographics, admission physiology, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (HLOS), intensive care unit (ICU) LOS, ventilator days, field time when available, and mortality were collected. Multivariate analysis was used to determine the independent effect of location of intubation on in-hospital mortality. Results: 422 patients were identified. 102(24%) patients were FI and 320(76%) were TCI. In the FI group, 86(84%) had blunt and 12(12%) penetrating injuries. In the TCI group, 248(78%) blunt, 65(20%) penetrating. There was no significant difference in age between the two groups. FI patients had significantly higher ISS (27.8 vs. 20.7, p<0.0001) and lower GCS (4.8 vs.10.8, p<0.0001). FI patients had significantly longer field time (1.3 vs. 0.8 hours, p<0.0001). In unadjusted analysis, FI patients had significantly higher mortality rates (40% vs.15%, p<0.0001) and ventilator days (7.2 days vs. 5.5 days, p=0.004). ICU and HLOS were not significantly different (6.3 days vs. 4.6 days, p=0.063; 8.9 days vs. 7.8 days, p=0.95). In adjusted analysis, there was no difference in outcome based on location of intubation with respect to mortality, HLOS, ICU LOS, and ventilator days. Conclusion: Despite previous reports, in a mature trauma system, field intubations are not independently associated with worse outcomes. Further studies are needed to determine the ideal location of intubation to improve outcome following injury.
Notes Poster 09
OUTCOMES FOLLOWING SUPERSELECTIVE ANGIOEMOBLIZATION FOR GASTROINTESTINAL HEMORRHAGE
David King*, MD, Hasan B Alam, MD, Oscar A Birkhan, MD, Catrina M Cropano, BS, Marc A. deMoya*, MD, Ayesha M Imam, MD, Sanjeeva Kalva, MD, Antonios C Sideris, MD, George C Velmahos, MD, T Gregory Walker, MD, Ali Y Mejaddam, M.D., Massachusetts General Hospital
Objectives: Therapeutic angioembolization is a relatively new treatment modality for gastrointestinal hemorrhage (GIH). The purpose of our study is to evaluate the safety and effectiveness of transcatheter superselective angioembolization (SSAE) for the treatment of GIH. Methods: A retrospective review of consecutive patients who underwent SSAE for GIH between January 2001 and June 2011 was performed. All patients with evidence of active contrast extravasation described on the radiology report were included. Data was collected on demographics, co-morbidities, clinical presentation, and type of intravascular angioembolic agent used. Outcomes included technical success (cessation of extravasation), clinical success (no rebleeding requiring intervention within 30 days), and incidence of ischemic complications. Results: 98 patients underwent SSAE for GIH during the study period; 47 were excluded due to lack of active contrast extravasation. Of the remaining 51 patients, 22 (43%) presented with a lower GIH and 29 (57%) with upper GIH. The majority were embolized with a permanent agent (71%), while the remaining patients received either a temporary agent (16%) or a combination (14%). The overall technical and clinical success rates were 98% and 71%, respectively. Of the 15 patients with rebleeding, 4 were managed successfully with re-embolization, while 2 underwent endoscopic therapy, and 9 had surgical resections. Only one patient had a major ischemic complication (jejunal infarction) requiring resection. Conclusion: SSE, with re-embolization if necessary, is an effective treatment modality for active GIH in 80% of patients. Ischemic complications are extremely rare.
Notes Poster 10
DVT IN TRAUMA PATIENTS: INJURY RELATED, NOT A MEASURE OF QUALITY OF CARE
Meredith S. Tinti*, MD, Adam M. Shiroff*, MD, Marianne Boylston, Non- member, Vicente H. Gracias*, MD, UMDNJ-Robert Wood Johnson U Hospital
Objectives: Due to Pay for Performance and new organizational definitions of quality of care, various conditions are being labeled as non-acceptable complications of health care. Deep venous thrombosis (DVT) is one condition that has been targeted as a measure of quality of care. We hypothesized that DVT is often related to mechanism of injury and not a lack of care provided by a health care institution. Methods: A retrospective study was performed by querying the Trauma Registry at our Level 1 Trauma Center for all patients that were diagnosed with a DVT or pulmonary embolism (PE) between January 2005 and December 2011. The data was then analyzed with regard to hospital days until diagnosis was made and with regard to mechanism of injury. Results: 288 patients with a diagnosis of DVT or PE were identified (2.67% of all Trauma patients) during the time period. 7.6% were diagnosed within 24 hours of admission. 11.1% were diagnosed between 24 and 48 hours and 12.2% between 48 and 72 hours. 30.9% of DVT/PE's were diagnosed in less than 72 hours from admission. Additionally, the rate of DVT amongst patients who required extrication from a vehicle at the scene was 5.88%, 2.2 times the rate in our general trauma population. Conclusion: Although our DVT/PE screening process does not routinely evaluate patients for these conditions until hospital day 3 or 4, nearly one third of our patients with thromboembolic events were diagnosed in less than 72 hours from the time of admission. The fact that the DVT/PE rate is twice as high in patients with a documented extrication time at the scene of the injury, supports the theory that these events are related to mechanism of injury. The early thromboembolic events should be considered to be present on arrival or injury related and should not be used as measures of quality of care. Early screening methods may help elucidate this further.
Notes Poster 11
INTERMOUNTAIN RISK SCORE IS HIGHLY PREDICTIVE OF MORTALITY IN TRAUMA PATIENTS
Sarah Majercik, MD, MBA, FACS, Benjamin Horne, PhD, MPH, FACC, Stacey Knight, PhD, MStat, Jolene Fox, RN, Mark H. Stevens*, MD, FACS, Intermountain Medical Center
Objectives: The Intermountain Risk Score (IMRS) uses components of the admission complete blood count (CBC) and basic metabolic profile (BMP) to predict mortality. IMRS has been validated in medical and cardiology patients, but has not been evaluated in trauma patients. This study tested whether IMRS is predictive of mortality in a trauma population at a Level One trauma center. Methods: Admitted trauma patients with CBC and BMP from October, 2005 -December, 2011 were evaluated. Sex-specific 30-day and 1-year IMRS values were calculated using multivariable modeling of components of the CBC, BMP, and patient age. Three risk thresholds were established (high, medium, low). Actual mortality was determined using the medical record and Social Security Administration death data. Results: 3637 females and 5901 males were evaluated at 30 days and 1 year. IMRS was highly predictive of death at 30 days (c=0.772 for females, c=0.783 males) and 1 year (c=0.778 for females, c=0.831 males). Cox regression analysis, adjusted for injury severity score, blunt vs. penetrating, and length of stay, showed increased mortality risks among patients in the moderate and high risk IMRS-defined groups at both 30 days and 1 year, with hazard ratios (table) ranging from 4.96-57.88 (all p<0.001). Conclusion: IMRS strongly predicts mortality in trauma patients at this single Level I trauma center. The ability to quickly and accurately determine a patient's mortality risk at the time of admission makes IMRS a powerful and potentially clinically important tool.
Notes Poster 12
UNCONTROLLED HEMORRHAGIC SHOCK RESULTS IN A HYPERCOAGUABLE STATE MODULATED BY INITIAL FLUID RESUSCITATION REGIMENS
Gordon M Riha, MD, Nicholas R Kunio, MD, Philbert Y Van, MD, Igor Kremenevskiy, MD, PhD, Ross Anderson, BS, Gregory J Hamilton, BS, Jerome A Differding, MPH, Martin A. Schreiber*, MD, FACS, Oregon Health & Science University
Objectives: Previous studies have shown large volume resuscitation modulates coagulopathy and inflammation. Our objective was to analyze the effects of initial bolus fluids utilized in military and civilian settings on coagulation and inflammation in a prospective, randomized, blinded trial of resuscitation of uncontrolled hemorrhage. Methods: Fifty swine were anesthetized, intubated, ventilated, and had monitoring lines placed. A grade V liver injury was performed followed by 30 minutes (30') of hemorrhage. After 30', the liver was packed, and randomized fluid resuscitation was initiated over a 12' period with two liters of normal saline (NS), two liters of Lactated Ringer's (LR), 250 ml of 7.5% saline with 3% Dextran (HTS), 500 ml of Hextend, or no fluid (NF). Animals were monitored for 2 hours post-injury. Thrombelastograms (TEGs), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, as well as serum IL-6, IL-8, and TNF-α levels were drawn at baseline, 1 and 2 hours. Results: The NF group had less post-treatment blood loss compared to other groups, p < 0.01. Blood loss was similar in the other groups. TEG R-values in each group were decreased at 1 and 2 hours compared to baseline, p < 0.02 (Figure 1). NS, HTS, and HEX had lower TEG-MA values compared to NF, p < 0.02. All fluids except LR resulted in significant increases in PT and decreases in fibrinogen compared to NF, p < 0.02. Fluid resuscitation groups as well as the NF group demonstrated significant increases in inflammatory cytokines from baseline to 1 hour and baseline to 2 hours. There were no significant differences in inflammatory cytokines between groups at 2 hours (Figure 2). Conclusion: Withholding fluid resulted in the least significant change in PT, fibrinogen, and MA, and the lowest post-treatment blood loss. Resuscitation with different initial fluid resuscitation strategies did not result in increased pro-inflammatory mediators compared to no fluid.
Notes Poster 13
EVALUATION OF THE RISK OF NONCONTIGUOUS FRACTURES OF THE SPINE IN BLUNT TRAUMA
Daniel W Nelson, DO, Matthew J. Martin*, MD, Niels Douglas Martin*, MD, Alec Beekley, MD, Madigan Army Medical Center
Objectives: There is significant debate over the risk of additional noncontiguous (NC) fractures among blunt trauma patients with an identified spinal injury, often prompting routine full spine imaging. We sought to determine the incidence of NC spinal fractures and the relationship between injury pattern and mechanism. Methods: A review of all adult blunt trauma patients from the 2010 National Trauma Databank with a spine fracture. Patient demographics, mechanism of injury and frequencies of all combinations of spinal fractures were analyzed. Results: Among 654,052 blunt trauma patients, 83,338 (13%) had a diagnosed spine fracture. The mean ISS was 15 + 11. Of these, 7% (5,496) sustained spinal cord injury and 17% (14,413) underwent spinal surgery. The overall incidence of NC fractures was 22% and was associated with severe truncal injuries, primarily involving the chest. The relative incidences of cervical, thoracic and lumbar fractures were 41% (34,480), 37% (30,383), and 43% (35,778) respectively. Rates of NC fractures of the spine included 9% (7,406) cervicothoracic, 4% (3,415) cervicolumbar, and 10% (7,929) thoracolumbar. The slight majority (57%) of patients with spinal fractures sustained high velocity trauma compared to 43% associated with low velocity trauma. However, NC fractures of the spine were strongly associated with high velocity trauma (Figure). Conclusion: Spine fractures are relatively common with blunt trauma, and approximately 20% will have a NC fracture. NC fractures were associated with other severe injuries and should be mainly suspected and investigated in high velocity mechanisms.
Notes Poster 14
INCREASED MORBIDITY AND MORTALITY OF TRAUMATIC BRAIN INJURY IN VICTIMS OF NONACCIDENTAL TRAUMA
Katherine Deans, MD, MHSc, Peter C Minneci, MD, MHSc, Wendi Lowell, CAISS, Jonathan I. Groner*, MD, Nationwide Children's Hospital
Objectives: The purpose of this study was to determine if the morbidity and mortality associated with traumatic brain injury (TBI) is worse in children who are victims of nonaccidental trauma (NAT) compared to TBI from other traumatic mechanisms. Methods: We identified all pediatric patients admitted with the diagnosis of TBI between 2001-2010 in our institutional trauma registry with an Abbreviated Injury Score (AIS) >1. Patients were divided into groups based on a nonaccidental (NAT) or accidental mechanism of injury. Need for gastrostomy tube insertion was used as a marker of more severe neurologic morbidity in survivors of TBI. Group comparisons were made using Fisher's exact tests. Results: 2,782 patients with TBI were included. 315 (11.3%) patients had TBI secondary to NAT. Overall mortality and AIS-specific mortality were higher in patients with TBI secondary to NAT (Table). In comparison to patients with TBI secondary to accidental mechanisms, patients with TBI secondary to NAT were younger (mean 1 vs. 8 years), had longer ICU stays (mean 3 vs. 1 days), and required gastrostomy tubes more often (6% vs. 1%, p<0.0001). Even amongst the subgroup of patients with severe TBI, (AIS 4 and 5), patients with NAT required gastrostomy tubes more often (5% vs. 2%, p=0.014). Conclusion: Patients with TBI from NAT have increased morbidity and mortality compared to patients with TBI from accidental mechanisms; these differences are present at all levels of severity of injury. Patients with TBI from NAT represent a vulnerable group of pediatric trauma patients that are at increased risk of death and worse outcome and that will require greater short and long term medical resources.
Notes Poster 15
MAINTENANCE OF NORMOTHERMIA IMPROVES FUNCTIONAL OUTCOME IN SEVERE CLOSED HEAD INJURY PATIENTS
Kara E Friend, MD, L. D. Britt*, MD, Rebecca C Britt, MD, Jessica Robin Burgess, MD, Jay N. Collins*, MD, Timothy J. Novosel*, MD, Leonard J. Weireter Jr.*, MD, Eastern Virginia Medical School
Objectives: The deregulation of the hypothalamic axis and subsequent hyperthermic response have been shown to be deleterious to full recovery in closed head injuries. Cooling catheters have been suggested to maintain normothermic states. Methods: All patients age 18-80 diagnosed with severe closed head injury from June 2010 – May 2012 were evaluated. Cooling catheters were placed in the femoral vein within 24 hours of admission. Cooling catheters maintained the patient at 97 degrees Fahrenheit. APACHE II scores were calculated as was GCS score on admission and discharge. Other parameters assessed included mechanism of injury, CT findings, temperatures, mannitol use, hypertonic saline use, outcomes, and disposition. Results: 51 patients were evaluated, with a total of 17 receiving cooling catheters (CC). The average age for CC patients was 35.9 and 43.7 for controls (p=0.1322). The mean APACHE score for control patients score was 19.68 compared to 22.71 (p=0.1040) for cooling catheter patients. The average change in GCS score from admission to discharge was 3.96, with 2.32 for controls and 7.24 for cooling catheter patients (p=0.0068). 14 patients died, 10 controls (29.4%) and 4 CC patients (23.5%). 12 patients developed hypothermia (temp under 96.3), 2 with CC and 10 controls. The length of stay was longer at 22.6 days for CC patients and 9.76 for controls (p=0.0009). Mannitol use and 3% saline use were equal between the groups (p=0.4304 and p=0.1657). Maximum temperature in CC patients was 101.8 and 101.1 in the control population (p=0.2351). Infectious complications occurred in 9 times in patients (26.5%) and 16 times in the CC patients(94%). Infections complications included blood stream infection, urinary tract infections, pneumonias and no episodes of clostridium difficile. There were no vascular complications from the placement of lines in either group. Conclusion: Early data from cooling catheter patients suggests an improvement in neurologic outcome but an increased infection rate.
Notes Poster 16
IMPACT OF IMPLEMENTATION OF AN ACUTE CARE SURGERY SERVICE ON PERCEPTIONS OF PATIENT CARE AND RESIDENT EDUCATION
Monisha Sudarshan, MD, Liane Feldman, MD, FRCSC, Etienne St. Louis, DEC, Mostafa Al-Habboubi , MD, Muhamad Elhusseini, MD, Paola Fata, MD, Dan Leon Deckelbaum, MD, Tarek S. Razek*, MD, Kosar A. Khwaja*, MD, MBA, MSc, FACS, McGill University
Objectives: Our objective was to document the impact of implementation of an Acute Care Surgery (ACS) service on perceptions of quality and efficiency of emergency surgical care and education. Methods: Prior to ACS service implementation at a large teaching hospital, a 34 item web-based survey evaluating perceptions of the quality of emergency surgical care and education was distributed to staff surgeons (SS) and general surgery residents (GSR). One year after ACS, the perceptions of the SS and GSR who had rotated on the service were re-evaluated with the same survey. Responses were graded on a 5 point Likert scale and a 3-point progress scale. Responses on the Likert scale were graded and compared pre and post ACS with Mann Whitney U-tests. p <0.05 was considered significant. Results: The pre-ACS response rate was 7/9 (78%) for SS and 36/60 (60%) for GSR. The post-ACS response rate was 10/10 (100%) for SS and 11/20 (55%) for GSR. The time to see consults were considered to have decreased by 8/10 (80%) of SS post-ACS. The sign-out system between staff was also considered to have improved by 5/10 (50%) of SS post-ACS. The impact of ACS duties on elective OR, clinics and research did not appear to change post-ACS for SS (p=NS). All SS (10/10) surveyed believed there was more opportunity to assess resident's knowledge, with improvement in their clinical skills post ACS. Patient care was also considered to be more efficient by 9/11(82%) of GSR with the ACS model, with an improvement in resident sign-over procedures (p=0.0018). Residents also thought they received more teaching around cases by staff when managing ACS patients (p=0.0004). The ACS model was considered to have improved the general surgery training for 8/11 (72%) of residents, with 9/11 (82%) believing that their ability to review patients with staff and leadership skills (8/11 (72%)) had improved. Conclusion: Surgeons and residents consider the ACS model has a positive impact on timely care, trainee knowledge, management and leadership skills.
Notes Poster 17
VENA CAVA FILTER (VCF) RETRIEVAL RATES ARE DEPENDENT UPON PROTOCOL AND PATIENT DISPOSITION
Paul D. Colavita, MD, A. Britton Christmas*, MD, FACS, John M. Green*, MD, Peter E. Fischer*, MD, MS, Korsica Lassiter, BS, Ronald F. Sing*, DO, Carolinas Medical Center
Objectives: VCF are commonly inserted in both critically ill, trauma and non-trauma patients. Recent studies demonstrate that VCF registries improve follow-up and retrieval rates. This study evaluates patient follow-up in the trauma compared to the non-trauma population. Methods: A prospectively collected registry of VCF insertions and retrievals at a single hospital was reviewed from 2006 to 2010. Patients who died prior to retrieval were excluded. Data collected included: demographics, patient disposition, complications, and compliance (contacted and agreed to retrieval attempt). Nominal variables were evaluated using chi-square analysis. Results: VCF were placed in 545 patients; 488 were contacted for follow-up (57 deaths). Male/female = 69%/31%, mean age 41.9 years. Trauma patients comprised 82% of the population. Only 37% of patients were compliant; of those, 87% were successfully retrieved. Retrieval was unsuccessful in 10.8% and not attempted in 2.7%. Mean implant time was 149.5 days (range 14-927). Younger patients were more likely to be compliant (compliant vs noncompliant: 38.2 vs 44.1 yrs, p<0.05), while patient gender had no effect. Trauma patients were compliant more often than others (40.1% vs 26.7%, p=0.021). 34.3% of patients discharged to rehabilitation, skilled nursing, or long-term facilities completed follow-up compared with 48.0% of patients discharged to home (p=0.008). After a non-home discharge, trauma patients were more compliant (37.7%) than non-trauma patients (3.4%, p<0.0001). Insertion complications were infrequent (<6%) and similar with regard to compliance. Late complications occurred in 19.2% of patients with follow-up. Conclusion: Disposition plays a key role in follow-up for VCF retrieval. Patients discharged to medical facilities have lower rates of follow-up than those discharged home. Trauma patients are more likely to follow-up after VCF placement, particularly due to a formal registry and contact protocol.
Notes Poster 18
COMPARISON OF AN UNVENTED (HALO®) WITH A VENTED (BOLIN™) CHEST SEAL FOR TREATMENT OF PNEUMOTHORAX (PTX) AND PREVENTION OF TENSION PTX IN A SWINE MODEL
Bijan S Kheirabadi, PhD, Lorne H Blackbourne*, MD, Victor Covertino, PhD, Michael Dubick, PhD, Robert Gerhardt, MD, Harold Klemcke, PhD, Alexandra Koller, BS, Irasema Terrazas, MS, US Army Institute of Surgical Research
Objectives: Objective: Unvented Halo chest seals (CS) are preferred by medics for treating pneumothorax (PTx) on the battlefield because of their superior adhesiveness. Since no data exist, we compared the efficacy of the Halo CS with a vented CS (Bolin) in a swine PTx model. Methods: Methods: An open chest wound PTx was created in the left thorax of spontaneously air-breathing anesthetized pigs (n=8). A CS was applied over the injury and tension PTx was induced by incremental air injections (200 ml) into the pleural cavity via a cannula that also was used to measure intraplural pressure (IP). Both CS were tested on each pig in series with a respiratory recovery between tests following a restored baseline IP. Heart rate, blood pressure (MAP), central venous pressure, pulmonary artery pressure (PAP), venous O2 saturation (SvO2), cardiac output (CO), peripheral O2 saturation (SpO2), tidal volume (Vt), respiratory rate and IP were recorded throughout. Tension PTx was defined by a mean IP≥ +1mmHg and when any 4 of these 5 changes were present: MAP↓20%; CO↓20%; SvO2↓30%; Vt↓20%; PAP↑30%; and then confirmed by chest X-ray. PO2 and PCO2 were measured in blood at baseline and the end of each CS test. Results: Results: PTx produced immediate respiratory difficulty and significant ↑ in IP and PAP (Fig. 1) and ↓ in Vt, SpO2 and SvO2 (Fig. 2) with no change in other parameters. Sealing the wound with either CS returned all parameters to near baseline within 5 min. With the Bolin CS subsequent air injection equal to the total lung capacity (~2050 ml) produced no change in the above parameters. In contrast, Halo use led to deterioration of all parameters, hypoxemia and development of tension PTx in all instances after ~1275 ml air injection. Conclusion: Conclusion: CS with or without a venting valve provide immediate breathing comfort and improve blood oxygenation of patients with PTx. However, over time in the presence of an airway leak, an unvented CS can lead to tension PTx, hypoxemia, respiratory and cardiac arrest.
Notes
Poster 19
HOW SAFE IS THE BACK SEAT IN TRAFFIC CRASHES? A PROFILE OF SEVERE INJURIES AND OUTCOMES FOR RESTRAINED REAR OCCUPANTS
Tanya Charyk Stewart, MSc, Neil G. Parry*, MD, Kevin McClafferty, BSc, Jean-Louis Comeau, BEng, Michael Shkrum, MD, Jason Gilliland, PhD, Douglas D. Fraser, MD, PhD, London Health Sciences Centre
Objectives: To examine injury profiles, crash characteristics and outcomes of severely injured restrained rear occupants. Methods: Retrospective cohort of severely injured (ISS>12) patients involved in a traffic MVC as a restrained rear occupant of a passenger vehicle and treated at one of two regional Trauma Centres from 2001-10. Data were described and statistically compared by 4 age groups (child, 0-8 years; adolescent, 9-17 years; adult, 18-54 years; senior, 55+ years). Logistic regression modeling was completed for severe head/neck injury. Results: A total of 123 severely injured rear occupants were restrained (54%). Seniors had the highest proportion of restraint use (76%) and 18-54 year olds the lowest (42%; p=0.001). Children had significantly more severe head/neck injuries than older occupants (85% vs. 25%, 26%, 18% for adolescents, adults and seniors, respectively). Types of head injuries differed with more DAI, skull fractures, SDH, SAH, edema and contusions in children than older age groups (p<0.05). More children were seated in the middle rear than older occupants (27% vs. 17%, 5%, 0%, respectively; p=0.034). Crash details differed with more adults involved in single vehicle (44% vs. 12% child; 28% adolescent; 24% senior; p=0.012), frontal collisions (64% vs. 17% child, 48% adolescent; 43% senior, p=0.031). Middle rear seating position (OR=5.19; 95% CI 1.04-25.79), and use of an infant/child/booster seat (OR=19.15; 95% CI 3.71-98.73) significantly increased the odds of sustaining a severe head/neck injury. Side rear seating was not significant. Children had the highest mortality rate (19% vs. 3%, 3%, 14%, respectively, p=0.042). Conclusion: Severe injuries occur to rear occupants, despite restraint use. Injury types and severity varied by age group with children < 9 years of age being at most risk of severe head/neck injury and death. Real-world MVC data may aid in the design and improvement of rear occupant restraint systems for the prevention of injuries.
Notes Poster 20
FINANCIAL IMPLICATION OF PROPOSED LEGISLATION ON HOSPITAL REIMBURSEMENT FOR THE INJURED DRUNK DRIVER
Patricia Anne Pentiak, MD, Claire Elise Peeples, MD, Holly A Bair, RN MSN NP, Felicia Ivascu*, MD, Oakland University Beaumont Health System
Objectives: The state of Michigan is one of 12 states to have no-fault automobile insurance, and is the only state that provides unlimited medical benefits. Due to high costs incurred from this, House Bill No. 5588 was proposed which would remove no-fault benefits if a person is found operating a motor vehicle or motorcycle while intoxicated or impaired at the time of the accident, regardless of responsibility. In this study, we examined the financial implications to hospitals that care for these patients. Methods: We conducted a retrospective review of our level 1 trauma center's trauma registry from 2008-2010. Admitted injured drivers of motor vehicle crashes (MVC), of legal drinking age (>21 years) were included. Intoxicated drivers were defined as those with a blood alcohol level above the legal limit (0.08g/dL). Hospital admission criteria and all costs pertaining to admission and treatment were obtained. Results: Of the 541 total drivers admitted after a MVC, 10.9% (59) were found to be legally intoxicated. Hospital financial data was available for 52 intoxicated and 482 sober patients. The total charges for all legally intoxicated drivers were $5.2 million which accounts for 12% of all charges for drivers. This leads to a contribution to the margin of $2.4 million with 74% of this paid by auto insurance. Conclusion: Due to the large cost and thus revenue created by treating these patients passage of Bill 5588 would significantly impact hospitals treating intoxicated drivers. There would be a 12% reduction in net revenue generated from the care of injured drivers. This will lead to a large financial burden for hospitals that treat intoxicated drivers requiring them to either absorb this cost or pass it on to Medicaid.
Notes
Poster 21
A NOVEL FLUOROSCOPY-FREE, RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION SYSTEM OF THE AORTA IN A PORCINE MODEL OF SHOCK
Robert Houston, IV, MD, Daniel J Scott, MD, Jeremy Cannon*, MD, SM, Jonathan L Eliason, MD, Jonathan Morrison, MRCS, Todd E Rasmussen, MD, James Dean Ross, Ph.D., Jerry Spencer, RVT, Carole Villamaria, MD, US Army Institute of Surgical Research
Objectives: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an alternative to aortic clamping in hemorrhagic shock. However, existing technology requires large-sheath arterial access and fluoroscopy for positioning. The objective of this study is to demonstrate the feasibility of a fluoroscopy-free REBOA system compared to current technology. Methods: Swine (70-90 kg) underwent controlled bleeding to class IV shock and underwent either 60 mins of REBOA using a commercially available balloon (CB, n=8) or a new prototype balloon (PB; n=8) designed as a consolidated wire and balloon system. Devices were introduced from the femoral artery and positioned and inflated in the thoracic aorta without fluoroscopy. Resuscitation for 6 hrs included blood, fluid and vasopressors and was followed by 48 hrs of survival and necropsy. Endpoints were survival, accuracy of position, mean arterial pressure (MAP), brain oxygen tension (PBrO2), lactate and necropsy results. Results: Post-hemorrhage, the MAP (mmHg) and PBrO2 (mmHg) was similar in the CB and PB groups (MAP: 35±8 vs 34±5; p=0.895 and PBrO2: 13±15 vs 44±83; p=0.204). Accurate positioning occurred in 88% of the PB group. Following REBOA, MAP and PBrO2 increased comparably in the CB and PB groups (MAP: 81±20 vs 89±16; p=0.211 and PBrO2: 26±24 vs 53±78; p=0.284 respectively). Lactate peaked in both CB and PB groups (10.8±1.4 vs. 13.2±2.1; p=0.012) 45 minutes post balloon deflation but returned to baseline by 24 hours. Mortality was similar between the CB and PB groups (1 (12%) vs 2 (25%); p=0.500) as was the rate of necrosis seen in cerebral (1 (12%) vs 0 (0%); p=1.000) and spinal tissue (3 (37.5%) vs 3 (37.5%); p=1.000). There was no evidence of injury to the aortic wall. Conclusion: This study reports the feasibility of a novel fluoroscopy-free REBOA system in a porcine model of shock. Despite the physiologic insult, 60 mins of REBOA is tolerated and recoverable. Additional study is necessary to refine the methodology of this resuscitative adjunct.
Notes Poster 22
RESUSITATIVE THORACOTOMIES IN U.S. COMBAT CASUALTIES: A TEN-YEAR REVIEW OF OPERATION ENDURING FREEDOM AND OPERATION IRAQI FREEDOM
Kevin B Waldrep, MD, Lorne H Blackbourne*, MD, Jeremy Cannon*, MD, SM, Kevin Chung, MD, Stephen Cohn*, MD, Timothy Wallum, MS, San Antonio Military Medical Center
Objectives: Historically, the use and indications for resuscitative thoracotomy (RT) in civilian trauma patients has been debated due to low rates of survival. We sought to review the experience with resuscitative thoracotomies for U.S. combat casualties wounded in OEF/OIF over the last decade of fighting. Methods: We queried the Joint Trauma Theater Registry for U.S. soldiers who received a thoracotomy the day of injury in OIF/OEF from January 2003 to May 2011. Coalition forces and civilian casualties were excluded from this study. A chart review was performed to ensure that only patients receiving a resuscitative thoracotomy were included. Of the 242 soldiers identified from the database, 148 soldiers met the inclusion criteria. Results: Incidence of RT in U.S. combat casualties was 0.6% (148/23,797 patients). Injuries resulting from explosives were the most common mechanism of injury (60.1%) vs. GSW (33.1%) vs. blunt trauma (6.7%). Overall survival was 14.8% with no significant difference in survivability for patients sustaining injuries from explosions (17.8%) vs. GSW's (10.2%) vs. blunt trauma (8.3%). There was no difference of ISS for survivors (31.7) compared to non-survivors (27.7). The ratio of FFP to pRBCs was higher for survivors than non-survivors (1:1.11 vs. 1:1.81 p<0.01 by chi-square analysis) Conclusion: Our study population has a rate of survival after resuscitative thoracotomy similar to previous reports from either military conflicts or the civilian setting. This procedure is useful in the military setting and will produce a significant percent of neurologic survivors.
Notes Poster 23
THE INCIDENCE AND IMPACT OF PRESCRIPTION CONTROLLED SUBSTANCE USE AMONG INJURED PATIENTS AT A LEVEL ONE TRAUMA CENTER
Matthew Bozeman, MD, Kimberly Broughton-Miller, ARNP, Michelle Frisbie, ARNP, Karina Pentecost, ARNP, Jodi Wojcik, ARNP, Robert Cannon, MD, Jason Smith*, MD, Brian G. Harbrecht*, MD, Glen A. Franklin*, MD, Matthew Benns*, MD, University of Louisville
Objectives: There has been increasing attention focused on the epidemic of prescription drug use in the United States, but little is known about its effects in trauma. The purpose of this study was to define the incidence of prescription controlled substance use among trauma patients and determine its effects on outcome. Methods: A retrospective review of all injured patients admitted to a level 1 trauma center from January 1, 2011 to December 31, 2011 was performed. Patients who died within 24 hours of admission or whose outpatient medications were unknown were excluded. Data review included home benzodiazepine or narcotic use, gender, age, mechanism of injury, injury severity scores (ISS), intensive care unit (ICU) and overall length of stay, and overall cost. SAS version 9.3 was used for analysis and p≤.05 was considered statistically significant. Results: 2983 patients were admitted during the study time period and 1797 met inclusion criteria. Overall incidence of prescription controlled substance use was 19.7%. Patients using benzodiazepines and/or narcotics were more likely to be women (27.3% vs 16.2%, p<.001), older (48.2 years vs 43.7 years, p<.001), had a longer mean ICU length of stay (3.6 vs 2.6 days, p=.042), and a longer mean hospital length of stay (8.0 vs 6.6, p=.021). ISS and mechanism of injury were not different between groups. Overall cost was greater in drug users (151,651 dollars vs 92,665, p=.173), but did not reach significance due to wide variability in charges. Conclusion: One-fifth of injured patients at our trauma center report the use of prescription controlled substances on admission. Users of these medications are more likely to be women and of older average age. Hospital and ICU length of stays were longer for controlled substance users with no difference in ISS between groups. Outpatient use and abuse of these medications can increase the overall healthcare burden given the large number of patients admitted nationwide following trauma.
Notes
Poster 24
EARLY TRAUMATIC BRAIN INJURY SCREENING IN 6,594 INPATIENT COMBAT CASUALTIES
David Zonies*, MD, Kathleen D. Martin*, RN, MSN, John Jones, BA, Jean Orman, ScD, MPH, Landstuhl Regional Medical Center
Objectives: Traumatic brain injury (TBI) has been coined the "signature wound" during current U.S. combat operations. All patients injured in Iraq or Afghanistan who transit through Landstuhl Regional Medical Center (LRMC) undergo an initial TBI screen regardless of anatomic injury. The incidence and factors associated with positive screening for concussion (physical event + alteration of consciousness (AOC)) and TBI diagnoses were examined. Methods: A retrospective review of consecutively admitted patients to LRMC who underwent a TBI screen from 5/06-7/11 was performed. Baseline characteristics, self-reported symptoms, and TBI diagnoses were analyzed. Results: Among 43,852 patients screened during the 5-year period, 6,594 were admitted. Predominantly male (97.1%), the mean age was 26.7 ± 7.4 yrs. The average GCS and ISS was 13.9 ± 2.8 and 10.1 ± 8.6, respectively. Positively screened patients averaged 1.8 deployments, 61.9 experienced one or more blasts, 16% experienced one or more vehicular crashes, with 18.0% reporting a prior head injury. Of the 2,806 (42.6%) who screened positive for possible concussion, 2,393 (85.3%) were diagnosed with a concussion/TBI during their inpatient stay; the remaining 412 (14.7%) were identified by screening only. A total of 1,953 (69.6%) of those who screened positive reported 1 or more concussion/TBI-related symptoms at the time of screening, while 532 (27.2 %) reported 5 or more. Conclusion: Early screening based on self-report identified a large number of patients admitted directly from the combat zone with possible deployment-related concussion and TBI symptoms. Such screening provides valuable information to guide decisions about early management and return to duty.
Notes Poster 25
DOES CARING FOR TRAUMA PATIENTS LEAD TO PSYCHOLOGICAL STRESS IN SURGEONS?
Ann Marie Warren, Ph.D., Shahid Shafi*, MD, MPH, Monica Bennett, Ph.D., Michael Foreman, MD, Kenleigh Roden-Foreman, BS, Alan Jones, MD, Baylor University Medical Center
Objectives: Post Traumatic Stress Disorder (PTSD) has been shown to occur in caregivers of trauma patients, including healthcare providers. Surgeons routinely care for the injured but the impact of this exposure on their psychological health has not been well studied. We hypothesized that caring for trauma patients is associated with symptoms of PTSD among surgeons. Methods: Surgeons in various specialties (n=133) were surveyed Jan-May 2012 at two regional surgical conferences. Symptoms of PTSD were identified utilizing the Secondary Traumatic Stress Scale (STSS) which uses specific diagnostic criteria to measure the psychological impact of exposure to trauma patients. Resilience, a positive psychological trait that may protect against PTSD, was measured using the Connor Davidson Resilience Scale, and compared to general population norms. The amount of time caring for trauma patients was used as a measure of risk exposure. The relationship between STSS, resilience and exposure to trauma patients was measured with p < .05 considered significant. Results: Mean age of the participants was 48±16.5 years and 83% were males. Twenty eight surgeons (22%) met diagnostic criteria for PTSD. Approximately two thirds of the surgeons (86 of 133, 65%) exhibited at least one symptom of secondary stress. However, the magnitude of exposure to trauma patients was similar between surgeons with and without PTSD (p = 0.2177). Surgeons exhibited higher resilience scores than general population (33±4 vs. 32±5, p .0012). Higher resilience scores were associated with lower STSS (r -0.369, p <0.0001). Most importantly, surgeons who met criteria for PTSD exhibited significantly lower resilience scores (31±3.4 vs. 34±3.9, p<0.0001). Conclusion: Caring for trauma patients is not associated with an increase in symptoms of PTSD among surgeons. However, symptomatic secondary stress is very common and its negative impact on surgeons may be minimized by utilizing techniques that improve resilience.
Notes Poster 26
NOT ALL MECHANISMS ARE CREATED EQUAL - A SINGLE-CENTER EXPERIENCE WITH THE NATIONAL GUIDELINES FOR FIELD TRIAGE OF INJURED PATIENTS
Lance E Stuke*, MD, MPH, Juan C. Duchesne*, MD, FACS, FCCP, Norman E. McSwain*, MD, FACS, NREMTP, Peter Meade*, MD, MPH, Patrick Greiffenstein, MD, Alan B. Marr*, MD, FACS, John P. Hunt III*, MD, MPH, Louisiana State University School of Medicine
Objectives: Trauma systems utilize pre-hospital evaluation of anatomic & physiologic (A&P) criteria and mechanism of injury (MOI) to determine trauma center need (TCN). MOI criteria are established nationally in a collaborative effort between the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons Committee on Trauma (ACS-COT) and have been revised several times, most recently in 2011. Controversy exists as to which MOI criteria truly predict trauma center need. We review our single-center experience with past and present National Trauma Triage Criteria (NTTC) to determine which MOI predict TCN. Methods: The trauma registry of an urban Level I trauma center was reviewed from 2001-10 for all patients meeting only MOI criteria. Patients meeting any A&P criteria were excluded. TCN was defined as death, ISS>15, emergency department transfusion, ICU admission, need for laparotomy/thoracotomy/vascular surgery within 24 hours of arrival, pelvic fracture, 2 or more proximal long-bone fractures, or neurosurgical intervention during admission. Logistic regression analysis was used to identify which MOI predict trauma center need. Results: 3,569 patients were transported to our trauma center who met only MOI criteria and had the MOI recorded in the registry. 821 MOI patients (23%) were identified who met our definition of TCN. Significant predictors of TCN included: death in the same passenger compartment, ejection from vehicle, extrication time > 20 minutes, fall > 20 feet, pedestrian thrown/run-over. Criteria not meeting TCN include vehicle intrusion, rollover MVC, speed > 40 mph, auto-pedestrian/auto-bicycle injury > 5mph, and both of the motorcycle crash (MCC) criteria (Table 1). Conclusion: With the exception of vehicle intrusion and MCC, the new NTTC accurately predicts TCN. Additionally, extrication time > 20 minutes was a positive predictor of TCN in our system. Elimination of the vehicle intrusion and MCC criteria and re-evaluation of extrication time merits further study.
Notes Poster 27
PARTIAL TRAUMA TEAM ACTIVATIONS: WHAT ARE WE IDENTIFYING?
Nathan T. Mowery*, MD, Michael C. Chang*, MD, Jason Farrah, MD, Amy Hildreth*, MD, Wake Forest University Medical School
Objectives: The efficacy of a tiered trauma triage system has been proven but the utility of the individual criteria is not established. Many institutions use criteria designed for field triage based on mechanism for their partial trauma team activation (PTA) criteria with the goal being identification of significantly injured patients (ISS≥ 16). The goal of this study was to evaluate which criteria were associated with the need for urgent intervention. Methods: The criteria used in 6322 PTA in our Level 1 Trauma Center over an 8 year period were evaluated for correlation with emergency surgery (ES, first 2 hours of admission) and mortality. A cohort matched for ISS, age, mechanism and admission blood pressure was created from the non-leveled trauma patients to determine the effect of being a leveled code. Multiple logistic regression analysis with PTA criteria as the predictor variable were performed with ES or death as the outcome. Results: Amputation, stab to the torso, GSW to the proximal extremity and a neurovascularly compromised extremity were associated with the need for ES. Flail chest and suspected spinal cord injury were associated with an increased mortality. The remaining criteria were protective or had no association with death or ES. Referring hospital intubation, flail chest, and pelvic fractures were the only criteria associated with a median ISS>16. The matched comparison groups showed no difference in time to the OR (p= 0.4) and non-leveled patients had significantly lower mortality (2.6% vs. 5.0%, p=0.001). Conclusion: The majority of PTC have no association with the need for ES or death. They do not identify an ill population based on ISS. Patients who need urgent intervention are identified by the physiologic criteria that most trauma centers use as full trauma team activation criteria. These data suggest a critical evaluation of the necessity and purpose of PTA criteria is warranted.
Notes Poster 28
TRIAGE CRITERIA BASED ON BLUNT MECHANISM OF INJURY ARE OF LITTLE UTILITY
Cameron Best, BS candidate, Kimberly Barre, RN, Kevin M. Schuster*, MD, Rebecca M. Lofthouse*, BSN, Kimberly A. Davis*, MD, Yale University
Objectives: Over-triage is often cited as necessary to avoid under-triage and delays in trauma team activation. Mechanism of injury criteria have been steadily devalued with revisions of field triage criteria, however their utility after a complete field evaluation and discussion with an in-hospital trauma nurse remains unclear. To minimize over-triage we reviewed an extensive mechanism based two-tiered in-hospital trauma activation protocol designed to minimize under-triage. Methods: Prospectively, data was collected over a 21 month period (January 2010-September 2011). Activation criteria prompting unnecessary trauma team activation were determined. Demographics, mechanisms of injury and level of trauma activation were collected. Univariate analysis associated individual triage criteria with outcome measures (admission to floor, ICU, or OR, need for blood products within 24 hrs, and death within 24 hrs). Results: 6093 patients activated the trauma team, with full data sets available for 1886 (31%). Physiologic criteria, including hemodynamic instability and a GCS<9, were found to be highly predictive of all outcome measures, with odds ratios ranging from 6.5-30, depending on measure evaluated. Only a cavitary penetrating mechanism predicted all outcome measures (OR range 3.2-12.6). Falls from heights > 20 feet predicted admission but not severe injury. Physical exam findings of injuries above and below the diaphragm (OR 3.2-3.7) and more than one long bone fracture (OR 4.4-6.3) also predicted outcomes examined. Conclusion: The use of mechanistic in-hospital criteria to identify significantly injured patients requiring transfusion, operative intervention, admission to a unit other than a floor, or death results in significant over-triage. Only penetrating mechanisms of injury, certain physical exam findings, physiologic criteria and possibly fall from heights much greater than 20ft predict need for aggressive intervention in the early period post injury.
Notes Poster 29
EAST SURVEY: DETERMINING PRACTICE PATTERNS OF BLOOD PRODUCT TRANSFUSION IN PATIENTS WITH LETHAL BRAIN INJURY
Stancie Rhodes*, MD, Michael Mazzei, B.A., Meredith S. Tinti*, MD, Adam M. Shiroff*, MD, Hesham Ahmed*, MD, Marissa De Freese*, MD, Vicente H. Gracias*, MD, Robert Wood Johnson Medical School
Objectives: In response to the worldwide shortage of transplantable organs, some institutions have initiated Aggressive Donor Management (ADM) protocols designed to manage patients suffering lethal brain injury. These protocols include guidelines for invasive monitoring and correction of metabolic disorders, but no consensus exists regarding the use of blood products. Our objective was to survey current practice patterns among US Trauma Surgeons to further develop these guidelines. Methods: An anonymous survey was electronically distributed to all Trauma Surgeons in the Eastern Association for the Surgery of Trauma (EAST). The survey sampled participants' transfusion patterns. Questions regarding whether they would transfuse potential donors, and which products they were willing to transfuse and in what ratios were employed. The survey tool was validated using the Content Validity Index prior to its distribution. Results: A total of 285 EAST members (24.5%) completed the survey. Almost three-quarters (72.5%) of respondents agree with the aggressive management of brain injured patients for the purposes of donation, while less than 10% strongly disagree with it. Of those surveyed, 53.5% currently transfuse these patients, but there was no agreement as to how much blood product to administer. The respondents did not differ significantly; however those practicing in a suburban setting were more likely to agree with transfusion (77%, p < .04) than those in rural or urban settings. Conclusion: The majority of Trauma Surgeons surveyed agree with transfusing blood products in the severely brain injured patient, yet ADMs continue to lack transfusion guidelines. Inclusion may help standardize varying patterns between rural and more urban settings. Further investigation is needed to determine what the transfusion triggers and limits should be to maximize our donor conversion rates.
Notes Poster 30
A NOVEL FREE RADICAL STERILIZATION SYSTEM FOR BURN WOUND DISINFECTION
Benjamin David Sadowitz, MD, Czeslaw Golkowski, PhD, Kalenda Kasangana, MD, Mark Golkowski, PhD, Osama Abdel-Razek, MD, David Bruch, MS, Shreyas Roy, MD, CM, Anya Golkowski, Undergraduate, Louis Gatto, PhD, Guirong Wang, PhD, William H. Marx*, DO, FACS, Gary F Nieman, BA, SUNY Upstate Medical University
Objectives: Burn wound infection continues to drive up the 18 billion dollar a year cost of taking care of burn patients in the United States. Our group has developed a novel method of tissue disinfection using non-thermal plasma induced free radicals delivered in an air stream. Our objectives were threefold: (1) to create a porcine model of deep dermal burn wound infection, (2) to determine an optimal treatment time for disinfecting burn wounds with our device, and (3) to compare disinfection of burn wounds between our device and a standard-of-care treatment regimen with Silvadene. Methods: For all 3 objectives, female Yorkshire pigs (42.8-46 kg, 2 pigs/objective) were sedated and deep dermal partial thickness burn injuries were created using water at 95 °C in a bottle with the bottom replaced with plastic wrap placed in contact with the skin for 20 seconds. Burn wounds were then inoculated with Staphylococcus aureus and Pseudomonas aeruginosa (5.00E+09 CFU/burn). Histological preparations and quantitative cultures of burn wound biopsies were analyzed for bacterial load and depth of skin invasion. Results: Objective 1: Tissue analysis on post-burn day 7 demonstrated consistent creation of deep dermal burn wounds heavily colonized with bacteria to the level of the reticular dermis. Objective 2: Tissue analysis on post-burn day 7 showed that daily 10 min treatments with our device displayed a 10-100 fold reduction in bacterial load compared to daily 2 and 5 min treatments (Fig 1). Objective 3: Infected burn wounds were treated daily with either Silvadene or our device for 6 days. Tissue analysis on post-burn day 6 demonstrated between a 10- to 100-fold reduction in bacterial load in those wounds treated with our device compared to Silvadene (Fig 2) Conclusion: Our novel free radical sterilization system demonstrated a 10-100 fold reduction of bacterial load in infected burn wounds compared to Silvadene. This system has the potential to become a useful adjunct for burn wound treatment in the future.
Notes Poster 31
"IT TAKES A VILLAGE” TO RAISE RESEARCH PRODUCTIVITY: IMPACT OF A NURSE-LEAD TRAUMA INTERDISCIPLINARY GROUP FOR RESEARCH (TIGR) AT AN URBAN, LEVEL 1 TRAUMA CENTER
Elizabeth NeSmith*, PhD, MSN, APRN-BC, Regina Simione Medeiros*, DNP, MHSA, RN, Colville Harvey Ferdinand*, MD, Michael L. Hawkins*, MD, Steve Holsten*, MD, Keith O'Malley*, MD, Yanbin Dong, MD/PhD, Haidong Zhu, MD, John Catravas, PhD, Georgia Health Sciences University
Objectives: Few interdisciplinary research groups include basic scientists, pharmacists, therapists, nutritionists, & lab technicians in addition to RNs and MDs. Increasing interprofessional diversity within scientific teams working to improve trauma care is a goal of national organizations (including EAST and STN) that fund trauma research. Thus, doctorally-prepared nurses founded the Trauma Interdisciplinary Group for Research (TIGR) with a goal to improve research productivity in a Level 1 trauma center in the southeast, and measured the outcomes to quantify TIGR's effectiveness in achieving this goal. Methods: TIGR was initiated in Fall 2009 and regular meetings were held to discuss projects. Multidisciplinary members were immediately engaged and added to an existing NIH-funded, nurse-led project which aimed to test the hypothesis that accelerated biologic aging from chronic stress increases baseline inflammation and reduces inflammatory response to trauma (projected N=150). Pre- and post- data related to participant screening, recruitment, consent, and data collection were compared. Results: Screenings for the NIH-funded study increased from N=40 to N=313 in less than 1 year (8-fold increase). Consents increased from N=14 to N=70 (5-fold increase). Lab service fees were reduced from $300 to $5/participant (98% cost reduction). Research project submissions increased from N = 0 to N = 6 (600%), including 3 nurse-lead interdisciplinary submissions for federal funding. Dissemination products increased from N = 0 to N = 6 (600%). Conclusion: Adding professional diversity to our scientific team via TIGR was exponentially successful in improving research productivity and significantly reducing research costs. This success has resulted in many new research products and mentoring activities that the team prior to TIGR had not entertained. The team is now well-positioned to apply for more federally funded projects and more trauma clinicians are considering research careers than before.
Notes
Poster 32
PROSPECTIVE DETERMINATION OF OPTIMAL ANGIOGRAPHIC PROTOCOL IN NON OPERATIVE MANAGEMENT OF HIGHER GRADE BLUNT SPLENIC INJURY
Jay A. Requarth, MD, Jason Farrah, MD, Cynthia Weber Lauer*, MD, Wake Forest University School of Medicine
Objectives: Optimal non-operative management (NOM) of blunt splenic injury (BSI) is debated, and the role of splenic artery embolotherapy (SAE) remains unclear. A recent meta-analysis suggested those with grades III-V injuries experienced lower NOM failure rates if SAE was performed. Based on these concepts, we developed a comprehensive protocol of SAE referral in all hemodynamically stable patients with grade III-V BSI, and hypothesized that adherence to this algorithm would lead to lower failure rates of NOM. Methods: This was a prospective study of all patients admitted to our level I trauma center with BSI over a 5 year period. The treatment protocol included referral of all hemodynamically stable patients with grade III-V injury (and those with parenchymal blush) for SAE, distal embolization in patients with parenchymal vascular injury, measurement of splenic artery stump-aortic pressure gradient and proximal embolization in patients with ≥ 40mmHg drop in pressure. Success of NOM with this protocol was compared to NOM outcome for standard angiography including: no SAE, distal SAE or proximal and distal SAE based on the discretion of the angiographer. Results: 89 patients with grades III – V BSI were referred for angiography from 1/1/2007 to 6/22/2012. Patients undergoing NOM per protocol (n=46) had an overall failure rate of 2.2%. Those undergoing angiography but no SAE had a failure rate of 50% (n=10; p=0.0004l). Those receiving only distal SAE failed at a rate of 28.6% (n=14;p=0.009) and those undergoing proximal and distal SAE had a failure rate of 4.6% (n=65: p=0.6) Conclusion: Adherence to an algorithm including proximal and distal SAE in all hemodynamically stable grade III-V injuries significantly decreases NOM failure rates. Addition of measurement of splenic artery stump pressures may further improve failure rates but the role of this specific modality requires further investigation.
Notes Poster 33
RELIABILITY ADJUSTMENT: A NECESSITY FOR TRAUMA CENTER RANKING AND BENCHMARKING
Zain Ghani Hashmi, MBBS, Justin Dimick, M.D.,MPH, David T. Efron*, MD, FACS, Elliott R. Haut*, MD, FACS, Eric Schneider, PhD, Nabeel Zafar, MBBS, MPH, Edward E Cornwell*, M.D., FACS, FCCM, Adil H Haider*, MD, MPH, Department of Surgery, Johns Hopkins School of Medicine
Objectives: Currently trauma center quality benchmarking is based on risk adjusted observed:expected (O:E) mortality ratios. However, failure to account for number of patients has been recently shown to produce unreliable mortality estimates, especially for low volume centers. This study explores the effect of reliability adjustment (RA), a statistical technique developed to eliminate bias introduced by low volume, on risk-adjusted trauma center benchmarking. Methods: Analysis of the NTDB 2010 was performed. Patients ≥16 years of age with blunt or penetrating trauma and an Injury Severity Score (ISS) ≥ 9 were included. Using the standard, Trauma Quality Improvement Program (TQIP) methodology, risk-adjusted mortality rates were generated for each center and used to rank them accordingly. Hierarchical logistic regression modeling was then performed to adjust these rates for reliability employing an empiric Bayes approach. The impact of RA was examined by 1) Recalculating inter facility variations in adjusted mortality rates and 2) comparing adjusted hospital mortality quintile rankings before and after RA. Results: 652 facilities (with 265,278 patients) included. RA significantly reduced the variation in risk-adjusted mortality rates between centers from 52 fold (0.19%-9.86%) to only 2 fold (4.22%-9.03%) after RA. This reduction in variation was most profound for smaller centers. A total of 100 "best" hospitals and 24 "worst" hospitals based on current risk adjustment methods were reclassified after performing RA. Conclusion: "Reliability adjustment" dramatically reduces variations in risk adjusted mortality arising from statistical noise, especially for lower volume centers. Moreover, the absence of RA had a profound impact on hospital performance assessment, suggesting that nearly one of every five hospitals in NTDB would have been inappropriately placed amongst the very best or very worst quintile of rankings. RA should be considered while benchmarking trauma centers based on mortality.
Notes Poster 34
USING THE CHARLSON COMORBIDITY INDEX TO PREDICT OUTCOMES IN EMERGENCY GENERAL SURGERY
Etienne St. Louis, DEC, Monisha Sudarshan, MD, Tarek Razek*, MD, FACS, Liane Feldman, MD, FRCSC, Kosar A. Khwaja*, MD, MBA, MSc, FACS, McGill University
Objectives: We evaluated the role of the Charlson Comorbidity Index (CCI), a weighted comorbidity index that reflects cumulative increased likelihood of one-year mortality, in predicting peri-operative outcomes in an emergency general surgery population at a large Canadian teaching hospital. Methods: A retrospective chart review of emergency general surgery admissions in 2010 was conducted. Patients who had surgery were identified. Mode of surgery and CCI were recorded, as well as measures of outcome, including 30-day mortality, ICU admission, in-hospital complications, length of stay (LOS) and disposition at discharge. Data were analyzed using linear regression and univariate analysis, and considered statistically significant if p<0.05. Results: Of the 527 admissions to general surgery from the emergency room, 257 patients underwent a surgical intervention. The CCI scores ranged from 0 to 16. We observed a total of 14 deaths (5.4%), 30 ICU Admissions (11.7%) and 45 Non-Home Dispositions (NHD=17.5%). The average LOS was 9.37 days (range: 1-141, median=5), and the average number of complications was 0.44 (range: 0-7, median=0). Odds ratio (OR) of death was highest in the CCI 11-16 group with OR=9.96 [1.86-59.87] (p<0.05). For ICU admissions and NHD, the highest OR was found in the CCI 5-10 group, with OR=5.44 [2.46-12.08] (p<0.05) and OR=3.34 [1.69-6.58] (p<0.05), respectively. The results of univariate analysis are given in detail in the attached table. Using linear regression we determined that every additional point on the CCI score adds 1.43 days to LOS (p<0.05) and 0.12 complications (p<0.05) per admission. Conclusion: We have shown that the CCI is a valid tool for post-operative outcome prediction in the context of emergency general surgery.
Notes Poster 35
ACUTE CARE SURGICAL SERVICE: SURGEON AGREEMENT AT THE TIME OF HANDOVER
Richard Hilsden, Brad Moffat, MD, University of Western Ontario
Objectives: Acute care surgical teams are dedicated teams responsible for emergent surgical patients, which require regular handover between different surgeons. Minimal research has been conducted to determine the rate of clinical agreement during patient handover. Methods: This prospective cohort study was carried out with our acute care surgical service at a tertiary care teaching hospital. Participating surgeons were given a copy of the handover patient list each morning where, in a concealed manner, they indicated whether they agreed or disagreed with the patient management plan. Aspects of care over which they disagreed were also described. Disagreements were classified as major if they involved a change in diagnosis, time to OR, operative procedure or patient disposition. All others were classified as minor. Rate of disagreement was then calculated. Results: 6 staff surgeons agreed to participate. The study was conducted from January 2012 to March 2012. A total of 417 unique patients were handed over giving an average of 7.4 patients handed over daily. For the primary outcome, a total of 41 disagreements were recorded for a disagreement rate of 9.8%. 15 of the 41 disagreements were classified as major; for a major disagreement rate of 3.4%. Among the major disagreements 3 involved a delay to the OR, 4 represented a disagreement in diagnosis, 3 represent disagreements over operative decision-making, and 5 represented a disagreement over disposition decisions. Consultant to consultant disagreements were classified as major disagreements 62.5% of the time and consultant to resident disagreements were major 21% of the time (P=0.112). Patients among whom there was clinical disagreement were on average older; 63 YOA vs 57 YOA (P<0.05). Conclusion: Despite frequent handovers little research has been completed to determine the rate of disagreement over patient management among surgeons. This study demonstrated that the rate of clinical disagreement is low among surgeons participating in acute care surgery.
Notes Poster 36
ARE WE DELIVERING TWO STANDARDS OF CARE FOR PELVIC TRAUMA? INCREASED TIME TO ANGIOEMBOLIZATION AFTER-HOURS AND ON WEEKENDS IS ASSOCIATED WITH INCREASED MORTALITY
Diane Schwartz*, MD, Michael Medina, MD, Bryan A. Cotton*, MD, Elaheh Rahbar, PhD, Charles Wade, M.D., John B. Holcomb*, MD University of Texas Health Sciences Center
Objectives: We hypothesized that patients with pelvic fractures and hemorrhage admitted during daytime hours were undergoing angioembolization earlier than those admitted at night and on weekends, thereby establishing two standards of time to hemorrhage control. Methods: The trauma registry was queried for patients admitted 01/2008-12/2011 with pelvic fractures (AIS≥ 3), hemorrhagic shock, and transfusion of at least one unit of blood. Patients dying <30 minutes were excluded. The control group (DAY) was admitted 0730-1730 Monday-Friday, the study group (after hours, AHR) was admitted 1730-0730 or on weekends. Primary outcome: time from admission to angiography (IR). Secondary outcome: in-hospital mortality. Results: 191 patients met criteria, 45 DAY and 146 AHR. 103 died <24 hours and without undergoing IR (62% AHR vs. 29% DAY, p<0.001). 16 patients (all AHR) died while awaiting IR (p=0.032). 88 patients (32 DAY, 56 AHR) formed primary group of interest, those surviving to receive IR. While younger (median 30 years vs. 54, p=0.007), AHR patients were more tachycardic (median pulse 119 vs. 90, p=0.001) and had more profound shock (median base -10 vs. -6, p=0.006) on arrival. Time from CT scan to IR was longer in AHR group (176 min vs. 87, p=0.011). While not significant, AHR received more blood products in the first six hours (median 11 units vs. 5, p=0.203). Controlling for age, arrival physiology (ED vitals), anatomic severity (ISS) and degree of shock (base deficit), the AHR group had a 94% increased risk of mortality. Conclusion: AHR patients have a significant increase in time to angiography compared to DAY patients. Moreover AHR patients have an almost 100% increase in mortality. These results are even more dramatic considering the survival bias inherent in the AHR group (almost 10% died awaiting IR). While this is a single center study and retrospective in nature, it suggests that we are currently delivering two standards of care in trauma, depending on day and time of admission.
Notes organization
Board of Directors 2012-2013
Jeffrey Salomone, President Scott Sagraves, President-Elect Erik Barquist, Past President Kimberly Davis, Secretary/Treasurer Stanley Kurek, Jr., Recorder A. Britton Christmas, Director Bruce Crookes, Director Therese Duane, Director Juan Duchesne, Director Elliott Haut, Director Herbert Phelan, Director Tarek Razek, Director Shahid Shafi, Director Nicole Stassen, Director Carl Valenziano, Director
Representative to the Board of Governors of the American College of Surgeons
Joseph Minei
Representative to the Journal of Trauma and Acute Care Surgery Editorial Board
Juan Duchesne Standing Committees
Bylaws Committee City, State Term of Expiration Chairman: Herb Phelan Dallas, TX 2013 Members: Grant Bochicchio St. Louis, MO 2013 Chet Morrison Lansing, MI 2013 Martin Zielinski Rochester, MN 2013 Michael Ditillo New Haven, CT 2014 Raquel Forsythe Pittsburgh, PA 2014 Matthew Kozloff Ft. Lauderdale, FL 2014 Slobodan Jazarevic Port St. Lucie, FL 2015 Amber Kyle Jackson, MS 2015 Steven Vaslef Durham, NC 2015
Careers in Trauma City, State Term of Expiration Chairman: Nicole Stassen Rochester, NY 2015 Members: Robert Cherry Maywood, IL 2013 Jennifer Knight Morgantown, WV 2013 Peter Pappas Melbourne, FL 2013* Adam Fox Newark, NJ 2014 Julie Mayglothling Richmond, VA 2014 Adam Shiroff New Brunswick, NJ 2014 Joseph Kepros East Lansing, MI 2015 Joseph Sakran Fairfax Station, VA 2015 Cynthia Talley Lexington, KY 2015 Allison Wilson Morgantown, WV 2015
Ex-Officio Therese Duane Richmond, VA 2013* Shea Gregg Providence, RI 2013 Stephanie Montgomery Charleston, SC 2013
EAST Foundation Representative Patrick Reilly Philadelphia, PA
Information Management City, State Term of Expiration & Technology Chairman: Bruce Crookes Charleston, SC 2013 Members: Stephen Barnes Columbia, MO 2013 Mohammad Siddiqui Clarks Summit, PA 2013 Frederic Starr Chicago, IL 2013 Casey Thomas Maywood, IL 2013 Richard George Akron, OH 2014 John Lee Lancaster, PA 2014 Babak Sarani Washington, DC 2014 Laura Johnson Washington, DC 2015 Bellal Joseph Tucson, AZ 2015 Eugene Reilly Wyomissing, PA 2015 Edgardo Salcedo Sacramento, CA 2015
EAST Foundation Representative Fred Luchette Maywood, IL
Injury Control & Violence City, State Term of Expiration Prevention Chairman: A. Britton Christmas Charlotte, NC 2015 Members: Michel Aboutanos Richmond, VA 2013 Christopher Dente Atlanta, GA 2013 Alexander Eastman Dallas, TX 2013 Wendy Greene Washington, DC 2013 Marie Crandall Chicago, IL 2014 Tracey Dechert Boston, MA 2014 Thomas Duncan Ventura, CA 2014 Terence O’Keeffe Tucson, AZ 2014 Pina Violano New Haven, CT 2014 Kent Choi Iowa City, IA 2015 James Eubanks Memphis, TN 2015 Shannon Foster West Reading, PA 2015 Ali Mallat Ann Arbor, MI 2015 Marcela Ramirez Miami, FL 2015 Gregg Schaefer Morgantown, WV 2015 Vaishali Schuchert Pittsburgh, PA 2015 Tchaka Shepherd Lynwood, CA 2015 William Shillinglaw Asheville, NC 2015 Dionne Skeete Iowa City, IA 2015
Membership City, State Term of Expiration Chairman: Tarek Razek Montreal, Quebec 2013 Members: J. Bracken Burns Jacksonville, FL 2013 Kimberly Davis New Haven, CT 2013 Julie Mayglothling Richmond, VA 2013 Donna Nayduch Evans, CO 2013 Herb Phelan Dallas, TX 2013 Scott Sagraves Kansas City, MO 2013 Oliver Gunter Nashville, TN 2014 Lewis Somberg Milwaukee, WI 2014 Kathryn Tchorz Dayton, OH 2014 Gary Vercruysse Atlanta, GA 2014 Jaroslaw Bilaniuk Morristown, NJ 2015 Evert Eriksson Charleston, SC 2015 Geoffrey Funk Dallas, TX 2015 Maureen McCunn Philadelphia, PA 2015 Susan Rowell Portland, OR 2015 Douglas Schuerer St. Louis, MO 2015
Ex-Officio Edgardo Salcedo Sacramento, CA 2013
Nominating City, State Term of Expiration Chairman: Erik Barquist Kissimmee, FL 2013 Members: Jeffrey Salomone Phoenix, AZ 2013 Scott Sagraves Kansas City, MO 2013 Mark Gestring Rochester, NY 2013 Peter Rhee Tucson, AZ 2013
Program City, State Term of Expiration Recorder: Stanley Kurek, Jr. Ft. Pierce, FL 2014 Members: Lewis Kaplan New Haven, CT 2013 Preston Miller Winston-Salem, NC 2013 Kevin Schuster New Haven, CT 2013 Mark Seamon Camden, NJ 2013 Jeanette Capella Hollidaysburg, PA 2014 Peter Lopez Birmingham, MI 2014 Bryce Robinson Cincinnati, OH 2014 John Santaniello Maywood, IL 2014 Jeffrey Claridge Cleveland, OH 2015 David King Boston, MA 2015 A. Tyler Putnam Johnson City, TN 2015 Thomas Rohs, Jr. Kalamazoo, MI 2015
Ex-Officio A. Britton Christmas Charlotte, NC 2015 Juan Duchesne New Orleans, LA 2014 Nathan Mowery Winston-Salem, NC 2013 Nicole Stassen Rochester, NY 2015
Publications City, State Term Expiration Chairman: Juan Duchesne New Orleans, LA 2014 Members: Eric Bradburn Hershey, PA 2013 Gary Kaml New Haven, CT 2013 Adrian Maung New Haven, CT 2013 Adam Shiroff New Brunswick, NJ 2013 Michael Bard Greenville, NC 2014 Daniel Cullinane Marshfield, WI 2014 A. Peter Ekeh Dayton, OH 2014 Randeep Jawa Omaha, NE 2014 Alicia Mohr Newark, NJ 2014 Todd Nickloes Knoxville, TN 2014 Scott Armen Hershey, PA 2015 William Chiu Baltimore, MD 2015 Jennifer Knight Morgantown, WV 2015 George Koenig Philadelphia, PA 2015 Mark Shapiro Durham, NC 2015 Lance Stuke New Orleans, LA 2015
Scholarship City, State Term of Expiration
Chairman: Shahid Shafi Grapevine, TX 2014 Members: Mary Boggs Golden, CO 2013 Stuart Chow Dublin, OH 2013 Marc deMoya Boston, MA 2014 Mark McKenney Miami, FL 2014 Jason Smith Louisville, KY 2014 Suresh Agarwal Boston, MA 2015 Nicole Fox Haddonfield, NJ 2015 Charles Hu Scottsdale, AZ 2015 Asser Youssef Shreveport, LA 2015
Seniors City, State Term of Expiration Chairman: Carl Valenziano Mendham, NJ 2013 Members: Virginia Eddy Portland, ME 2013 Lawrence Lottenberg Gainesville, FL 2013 Patrick Reilly Philadelphia, PA 2013 Lewis Somberg Milwaukee, WI 2013 Riad Cachecho Upland, PA 2014 Debra Malone Cantonsville, MD 2014 Sidney Miller Columbus, OH 2014 Bruce Simon Worcester, MA 2014 Ernest Block Melbourne, FL 2015 Frederic Cole Portland, OR 2015 Peter Ehrlich Ann Arbor, MI 2015 Ronald Gross Springfield, MA 2015
Ad Hoc Committees
Acute Care Surgery City, State Term of Expiration Chairman: Therese Duane Richmond, VA 2014 Members: Raeanna Adams Nashville, TN Rahul Anand Richmond, VA Stephen Barnes Columbia, MO Tiffany Bee Memphis, TN John Como Cleveland, OH Tracey Dechert Boston, MA Jose Diaz, Jr. Baltimore, MD Paula Ferrada Glen Allen, VA Rajesh Gandhi Fort Worth, TX Joseph Gordon Danbury, CT Oliver Gunter Nashville, TN Matthew Indeck Hershey, PA Alicia Kieninger Pontiac, MI Gary Lidenbaum Philadelphia, PA Matthew Lissauer Baltimore, MD Heather Mac New Savannah, GA Addison May Nashville, TN Forrest Moore Phoenix, AZ Peter Pappas Melbourne, FL Charu Paranjape Akron, OH Douglas Paul Columbus, OH Anita Praba-Egge Lewiston, ME Robert Schulze Metuchen, NJ Niral Shah Brookline, MA Ruby Skinner Bakersfield, CA Deborah Stein Baltimore, MD Peter Thomas Bethlehem, PA Advanced Practitioners City, State Term of Expiration Chairman: William Hoff Bethlehem, PA 2013 Members: Melea Anderson Minneapolis, MN Alex Axelrad Atlantic City, NJ Marilynn Bartley Wilmington, DE William Bowling Flint, MI Riad Cachecho Upland, PA Elizabeth Crawford Vancouver, MA Raquel Forsythe Pittsburgh, PA Linda Galambos Chicago, IL David Hirschman Minneapolis, MN Joseph Jensen Little Rock, AR Brett Kuhlman Grand Blanc, MI Benjamin Laughton Baltimore, MD Lawrence Lottenberg Gainesville, FL Gina Luckianow Hamden, CT Amanda McNicholas Pottstown, PA Judy Mikhail Ann Arbor, MI John Osborn Rochester, MN Julia Senn-Reeves Rochester, MN Scott Sherry Portland, OR Corinna Sicoutris Philadelphia, PA Georgianna Telford Hockessin, DE Jeffrey Weisberger Fair Lawn, NJ Richard Winters Hoover, AL Susan Yeager Hilliard, OH Martin Zielinski Rochester, MN
Advocacy & Outreach City, State Term of Expiration Chairman: Bryan Cotton Houston, TX 2013 Vice Chair: Robert Barraco Allentown, PA 2013 Members: John Armstrong Tampa, FL Matthew Benns Louisville, KY Carla Carusone New Haven, CT Alexander Eastman Dallas, TX Toby Ennis Salt Lake City, UT Kirby Gross Fort Sam Houston, TX Ronald Gross Springfield, MA Oscar Guillamondegui Nashville, TN Jay Jenoff Marlton, NJ D’Andrea Joseph Hartford, CT Sidney Miller Columbus, OH Bryan Morse Greenville, SC John Osborn Rochester, MN
EAST Foundation Representative Lawrence Lottenberg Gainesville, FL Military City, State Term of Expiration Chairman: Joseph DuBose Baltimore, MD 2013 Vice-Chair: Timothy Nunez Franklin, TN 2013 Vice-Chair: Carlos Rodriguez Wheaton, MD 2013 Members: Scott Armen Hershey, PA Linda Atteberry Augusta, GA Jeremy Cannon San Antonio, TX Matthew Davis Temple, TX Stephen DiRusso Bronx, NY George Garcia Cooper City, FL Kirby Gross Fort Sam Houston, TX David King Boston, MA Brian Leininger Colorado Springs, CO Debra Malone Cantonsville, MD Zsolt Stockinger Portsmouth, VA Gary Vercruysse Tucson, AZ
Online Education City, State Term of Expiration Chairman: Andrew Bernard Lexington, KY 2013 Ernest Block Melbourne, FL Dale Dangleben Allentown, PA Gary Marshall Pittsburgh, PA Babak Sarani Washington, DC Carl Schulman Miami, FL
Pediatric Trauma City, State Term of Expiration Chairman: Richard Falcone, Jr. Cincinnati, OH 2013 Mary Aaland Fargo, ND Jeremy Cannon San Antonio, TX James DeCou Grand Rapids, MI Martin Keller St. Louis, MO Amber Kyle Jackson, MS Christopher Moir Rochester, MN David Mooney Boston, MA Todd Nickloes Knoxville, TN Stancie Rhodes New Brunswick, NJ Phillip Spinella St. Louis, MO Christian Streck Charleston, SC Steven Stylianos New Hyde Park, NY Pina Violano New Haven, CT
Practice Management Guidelines City, State Term of Expiration Chairman: Elliott Haut Baltimore, MD 2015 Section Chairs: J. Bracken Burns Jacksonville, FL 2012 John Como Cleveland, OH 2012 Adil Haider Baltimore, MD 2012 Oscar Guillamondegui Nashville, TN 2013
Research City, State Term of Expiration Chairman: Vicente Gracias New Brunswick, NJ 2013 Members: Jeannette Capella Hollidaysburg, PA Mark Cipolle Newark, DE Stephen Cohn San Antonio, TX Elliott Haut Baltimore, MD Nabil Issa Chicago, IL Felicia Ivascu Royal Oak, MI Matthew Martin Olympia, WA Christian Minshall Dallas, TX Mayur Patel Nashville, TN Carl Schulman Miami, FL Mark Seamon Camden, NJ Alison Wilson Morgantown, WV Tanya Zakrison Miami, FL Ben Zarzaur Memphis, TN
Rural Trauma City, State Term of Expiration Chairman: Rajan Gupta Lebanon, NH 2013 Members: Jeannette Capella Hollidaysburg, PA Bryan Collier Roanoke, VA Matthew Davis Temple, TX Juliet Geiger Mechanicsburg, PA James Haan Wichita, KS Michael Heid Cape Girardeau, MO Tomas Jacome Baton Rouge, LA R. Shayn Martin Winston-Salem, NC MaryClare Sarff Madison, WI Kristen Sihler Portland, ME Brett Waibel Greenville, NC PAST PRESIDENTS
1988 Kimball I. Maull Dispelling Fatalism in a Cause-and-Effect World 1989 Burton H. Harris Searching for Values in Changing Times 1990 Lenworth M. Jacobs, Jr. Forces Shaping Trauma Care 1991 Howard R. Champion Reflections on and Directions for Trauma Care 1992 C. William Schwab Violence: America’s Uncivil War 1993 Michael Rhodes Practice Management Guidelines for Trauma Care 1994 Carl Boyd On Timeless Principles in Changing Times 1995 James M. Hassett Do It Right, Do the Right Thing 1996 William F. Fallon Jr. Surgical Lessons Learned on the Battlefield 1997 John A. Morris Jr. The Evolving Role of the Scientific Society in the New Millennium 1998 Timothy C. Fabian Evidence-Based Medicine in Trauma Care – Whither Thou Goest? 1999 David B. Reath Why Am I Here? 2000 Paul R. G. Cunningham Leadership, Professional Heroism, and the Eastern Association for the Surgery of Trauma 2001 Eric R. Frykberg Disasters and Mass Casualties – How Can We Cope? 2002 Blaine L. Enderson Can Trauma Surgeons Survive Health Care Business? 2003 J. Wayne Meredith Trauma Surgery: Current Status and Future Directions 2004 Philip S. Barie Leading and Managing in Unmanageable Times 2005 Michael F. Rotondo The Rural Trauma Imperative: A Silent Killer in America’s Heartland 2006 Michael Pasquale Outcomes for Trauma: Is There an End (Result) in Sight? 2007 Kimberly K. Nagy Traditions, Innovations, and Legacies 2008 Ernest FJ Block Think Different 2009 Patrick M. Reilly Trauma Fellowship 2010 Donald H. Jenkins Union of Forces 2011 Erik S. Barquist It Matters: The Case for Advocacy
FOUNDING MEMBERS Howard R. Champion Burton H. Harris Lenworth M. Jacobs, Jr. Kimball I. Maull
PAST MEMBERS OF THE BOARD OF DIRECTORS
Founding Board Ray Alexander Andrew Burgess Howard R. Champion Thomas Gennarelli Burton H. Harris Lenworth M. Jacobs, Jr. Kimball I. Maull Norman E. McSwain Michael Rhodes C. William Schwab
1988 Kimball I. Maull President Burton H. Harris President Elect Howard R. Champion Secretary/Treasurer Lenworth M. Jacobs, Jr. Recorder/Program Chair Ray Alexander Local Arrangements Carl Boyd Director at Large Andrew Burgess Director at Large Thomas Gennarelli Director at Large David Kreis Director at Large Michael Rhodes Director at Large C. William Schwab Director at Large
1989 Burton H. Harris President Lenworth M. Jacobs, Jr. President Elect Kimball I. Maull Past President Michael Rhodes Secretary/Treasurer C. William Schwab Recorder/Program Chair Carl Boyd Director at Large Lawrence Bone Director at Large Robert Carraway Director at Large Alasdair Conn Director at Large Timothy C. Fabian Director at Large William F. Fallon, Jr. Director at Large David Kreis Director at Large
1990 Lenworth M. Jacobs, Jr. President Howard R. Champion President Elect Burton H. Harris Past President Michael Rhodes Secretary/Treasurer C. William Schwab Recorder/Program Chair Lawrence Bone Director at Large L. D. Britt Director at Large Robert Carraway Director at Large Alasdair Conn Director at Large Daniel Diamond Director at Large Timothy C. Fabian Director at Large William F. Fallon, Jr. Director at Large James Hassett Director at Large Michael Hawkins Director at Large John A. Morris, Jr. Director at Large
1991 Howard R. Champion President C. William Schwab President Elect Lenworth M. Jacobs, Jr. Past President Michael Rhodes Secretary/Treasurer Carl Boyd Recorder/Program Chair John Barrett Director at Large Susan Briggs Director at Large L. D. Britt Director at Large Daniel Diamond Director at Large Richard Gamelli Director at Large Gerardo Gomez Director at Large James Hassett Director at Large Michael Hawkins Director at Large John A. Morris, Jr. Director at Large David Reath Director at Large
1992 C. William Schwab President Michael Rhodes President Elect Howard R. Champion Past President William F. Fallon, Jr. Secretary/Treasurer Carl Boyd Recorder/Program Chair John Barrett Director at Large Christopher Born Director at Large Susan Briggs Director at Large Sylvia Campbell Director at Large Paul Cunningham Director at Large Richard Gamelli Director at Large Gerardo Gomez Director at Large David Reath Director at Large Thomas Scalea Director at Large
1993 Michael Rhodes President Carl Boyd President Elect C. William Schwab Past President William F. Fallon, Jr. Secretary/Treasurer John A. Morris, Jr. Recorder/Program Chair Christopher Born Director at Large Sylvia Campbell Director at Large Thomas Cogbill Director at Large Paul Cunningham Director at Large James Hurst Director at Large M. Gage Ochsner, Jr. Director at Large Thomas Scalea Director at Large Steven R. Shackford Director at Large
1994 Carl Boyd President James Hassett President Elect Michael Rhodes Past President William F. Fallon, Jr. Secretary/Treasurer John A. Morris, Jr. Recorder/Program Chair Christopher Born Director at Large Sylvia Campbell Director at Large Thomas Cogbill Director at Large Paul Cunningham Director at Large Brad Cushing Director at Large James Hurst Director at Large J. Wayne Meredith Director at Large M. Gage Ochsner, Jr. Director at Large Thomas Scalea Director at Large Steven R. Shackford Director at Large
1995 James Hassett President William F. Fallon, Jr. President Elect Carl Boyd Past President David Reath Secretary/Treasurer John A. Morris, Jr. Recorder/Program Chair Thomas Cogbill Director at Large Brad Cushing Director at Large Blaine Enderson Director at Large Sheryl G. A. Gabram Director at Large James Hurst Director at Large Rao Ivatury Director at Large J. Wayne Meredith Director at Large M. Gage Ochsner, Jr. Director at Large Grace Rozycki Director at Large Steven R. Shackford Director at Large
1996 William F. Fallon, Jr. President John A. Morris, Jr. President Elect James Hassett Past President David Reath Secretary/Treasurer Paul Cunningham Recorder/Program Chair Philip S. Barie Director at Large C. Gene Cayten Director at Large Brad Cushing Director at Large Blaine Enderson Director at Large Eric Frykberg Director at Large Sheryl G. A. Gabram Director at Large Rao Ivatury Director at Large J. Wayne Meredith Director at Large Galen Poole Director at Large Michael F. Rotondo Director at Large Grace Rozycki Director at Large
1997 John A. Morris, Jr. President Timothy C. Fabian President Elect William F. Fallon, Jr. Past President David Reath Secretary/Treasurer Paul Cunningham Recorder/Program Chair Nabil Atweh Director at Large Philip S. Barie Director at Large C. Gene Cayten Director at Large Blaine Enderson Director at Large Eric Frykberg Director at Large Sheryl G. A. Gabram Director at Large Rao Ivatury Director at Large Michael Pasquale Director at Large Galen Poole Director at Large Michael F. Rotondo Director at Large Grace Rozycki Director at Large
1998 Timothy C. Fabian President David Reath President Elect John A. Morris, Jr. Past President Blaine Enderson Secretary/Treasurer Paul Cunningham Recorder/Program Chair Nabil Atweh Director at Large Philip S. Barie Director at Large C. Gene Cayten Director at Large Martin Croce Director at Large Eric Frykberg Director at Large Orlando Kirton Director at Large Mary McCarthy Director at Large Michael McGonigal Director at Large J. Wayne Meredith Director at Large Michael Pasquale Director at Large Andrew Peitzman Director at Large Michael F. Rotondo Director at Large
1999 David Reath President Paul Cunningham President Elect Timothy C. Fabian Past President Blaine Enderson Secretary/Treasurer Michael F. Rotondo Recorder/Program Chair Nabil Atweh Director at Large Jack Bergstein Director at Large Martin Croce Director at Large Orlando Kirton Director at Large Mary McCarthy Director at Large Michael McGonigal Director at Large Kimberly Nagy Director at Large Michael Pasquale Director at Large Andrew Peitzman Director at Large
2000 Paul Cunningham President Eric Frykberg President Elect David Reath Past President Blaine Enderson Secretary/Treasurer Michael F. Rotondo Recorder/Program Chair Jack Bergstein Director at Large Ernest FJ Block Director at Large Collin Brathwaite Director at Large Martin Croce Director at Large Orlando Kirton Director at Large Mary McCarthy Director at Large Michael McGonigal Director at Large Kimberly Nagy Director at Large Andrew Peitzman Director at Large Patrick Reilly Director at Large L. R. “Tres” Scherer, III Director at Large
2001 Eric Frykberg President Blaine Enderson President Elect Paul Cunningham Past President Michael Pasquale Secretary/Treasurer Michael F. Rotondo Recorder/Program Chair Jack Bergstein Director at Large Ernest FJ Block Director at Large Collin Brathwaite Director at Large Samir Fakhry Director at Large Heidi Frankel Director at Large Fred Luchette Director at Large Kimberly Nagy Director at Large Lena Napolitano Director at Large Patrick Reilly Director at Large L. R. “Tres” Scherer, III Director at Large Gregory Timberlake Director at Large
2002 Blaine Enderson President J. Wayne Meredith President Elect Eric Frykberg Past President Michael Pasquale Secretary/Treasurer Kimberly Nagy Recorder/Program Chair Ernest FJ Block Director at Large Collin Brathwaite Director at Large Michael Chang Director at Large Samir Fakhry Director at Large Heidi Frankel Director at Large Fred Luchette Director at Large Lena Napolitano Director at Large Patrick Reilly Director at Large L. R. “Tres” Scherer, III Director at Large Amy Sisley Director at Large Gregory Timberlake Director at Large
2003 J. Wayne Meredith President Philip S. Barie President Elect Blaine Enderson Past President Michael Pasquale Secretary/Treasurer Kimberly Nagy Recorder/Program Chair Erik Barquist Director at Large Michael Chang Director at Large Samir Fakhry Director at Large Heidi Frankel Director at Large Mark Healey Director at Large Fred Luchette Director at Large Michael Nance Director at Large Lena Napolitano Director at Large Amy Sisley Director at Large Gregory Timberlake Director at Large Jeffery Young Director at Large
2004 Philip S. Barie President Michael F. Rotondo President Elect J. Wayne Meredith Past President Ernest FJ Block Secretary/Treasurer Kimberly Nagy Recorder/Program Chair Erik Barquist Director at Large Michael Chang Director at Large Brian Daley Director at Large Thomas Esposito Director at Large Jeffrey Hammond Director at Large Mark Healey Director at Large Fred Luchette Director at Large Michael Nance Director at Large Jeffrey Salomone Director at Large Amy Sisley Director at Large Jeffery Young Director at Large
2005 Michael F. Rotondo President Michael Pasquale President Elect Philip S. Barie Past President Ernest FJ Block Secretary/Treasurer Patrick Reilly Recorder/Program Chair Erik Barquist Director at Large Brian Daley Director at Large Thomas Esposito Director at Large Henri Ford Director at Large Jeffrey Hammond Director at Large Michael Nance Director at Large Scott Sagraves Director at Large Jeffrey Salomone Director at Large Glen Tinkoff Director at Large Jeffery Young Director at Large
2006 Michael Pasquale President Kimberly Nagy President-Elect Michael F. Rotondo Past President Ernest FJ Block Secretary/Treasurer Patrick Reilly Recorder/Program Chair Philip S. Barie Director at Large Brian Daley Director at Large Henri Ford Director at Large Jeffrey Hammond Director at Large Stanley Kurek Director at Large Joseph Minei Director at Large Jeffrey Salomone Director at Large Paul Taheri Director at Large Glen Tinkoff Director at Large
2007 Kimberly Nagy President Ernest FJ Block President-Elect Michael Pasquale Past President Erik Barquist Secretary/Treasurer Patrick Reilly Recorder/Program Chair William Charash Director at Large Kimberly Davis Director at Large Henri Ford Director at Large Mark Gestring Director at Large Stanley Kurek Director at Large Lawrence Lottenberg Director at Large Joseph Minei Director at Large Glen Tinkoff Director at Large Paul Taheri Director at Large
2008 Ernest FJ Block President Patrick Reilly President-Elect Kimberly Nagy Past President Erik Barquist Secretary/Treasurer Jeffrey Salomone Recorder/Program Chair Robert Barraco Director at Large Faran Bokhari Director at Large William Charash Director at Large Kimberly Davis Director at Large Mark Gestring Director at Large Stanley Kurek Director at Large Lawrence Lottenberg Director at Large Joseph Minei Director at Large Scott Sagraves Director at Large Paul Taheri Director at Large
2009 Patrick Reilly President Donald Jenkins President-Elect Ernest FJ Block Past President Erik Barquist Secretary/Treasurer Jeffrey Salomone Recorder/Program Chair Robert Barraco Director at Large Andrew Bernard Director at Large Faran Bokhari Director at Large William Charash Director at Large William Chiu Director at Large Kimberly Davis Director at Large Mark Gestring Director at Large Andrew Kerwin Director at Large Lawrence Lottenberg Director at Large Scott Sagraves Director at Large
2010 Donald Jenkins President Erik Barquist President-Elect Patrick Reilly Past President Kimberly Davis Secretary/Treasurer Jeffrey Salomone Recorder/Program Chair Robert Barraco Director at Large Andrew Bernard Director at Large Faran Bokhari Director at Large William Chiu Director at Large Bruce Crookes Director at Large Andrew Kerwin Director at Large Herb Phelan Director at Large Tarek Razek Director at Large Scott Sagraves Director at Large Carl Valenziano Director at Large
2011 Erik Barquist President Jeffrey Salomone President-Elect Donald Jenkins Past President Kimberly Davis Secretary/Treasurer Stanley Kurek, Jr. Recorder/Program Chair Andrew Bernard Director at Large William Chiu Director at Large Bruce Crookes Director at Large Therese Duane Director at Large Juan Duchesne Director at Large Andrew Kerwin Director at Large Herb Phelan Director at Large Tarek Razek Director at Large Shahid Shafi Director at Large Carl Valenziano Director at Large
PAST MEETINGS
1988 Colony Beach Resort Longboat Key, FL January 12-14, 1989 Colony Beach Resort Longboat Key, FL January 10-13, 1990 The Registry Hotel Naples, FL January 17-19, 1991 Colony Beach Resort Longboat Key, FL January 16-18, 1992 Hamilton Princess Hotel Bermuda January 13-16, 1993 Colony Beach & Tennis Resort Longboat Key, FL January 12-15, 1994 The Princess Hotel & Casino Freeport, Bahamas January 11-14, 1995 Sanibel Harbour Resort & Spa Ft. Myers, FL January 10-13, 1996 Walt Disney World Dolphin Lake Buena Vista, FL January 15-18, 1997 Sanibel Harbour Resort & Spa Ft. Myers, FL January 14-17, 1998 Sanibel Harbour Resort & Spa Ft. Myers, FL January 13-16, 1999 Wyndham Palace Resort & Spa Orlando, FL January 12-15, 2000 Sanibel Harbour Resort & Spa Ft. Myers, FL January 8-13, 2001 Westin Innisbrook Resort Tampa Bay Palm Harbor, FL January 15-19, 2002 Wyndham Palace Resort & Spa Orlando, FL January 15-18, 2003 Sanibel Harbour Resort & Spa Ft. Myers, FL January 14-17, 2004 Amelia Island Plantation Amelia Island, FL January 12-15, 2005 Marriott Harbor Beach Resort & Spa Ft. Lauderdale, FL January 11-14, 2006 Disney’s Contemporary Resort Lake Buena Vista, FL January 16-20, 2007 Sanibel Harbour Resort & Spa Ft. Myers, FL January 15-19, 2008 Amelia Island Plantation Jacksonville, FL January 13-17, 2009 Disney’s Yacht & Beach Club Resort Orlando, FL January 19-23, 2010 Sheraton Wild Horse Pass Resort Chandler, AZ January 25-29, 2011 Naples Grande Resort Naples, FL January 10-14, 2012 Disney’s Contemporary Resort Lake Buena Vista, FL
ANNUAL SCIENTIFIC ASSEMBLY GUEST SPEAKER
1988 Donald Frahn President and CEO Hartford Insurance Co.
1989 John Davis, MD Editor, Journal of Trauma Professor and Chair, Department of Surgery University of Vermont
1990 Robert M. Zollinger, MD Professor and Chair, Emeritus Department of Surgery Ohio State University
1991 Francis Moore, MD Mosley Professor of Surgery Emeritus Department of Surgery Harvard Medical School
1992 Donald D. Trunkey, MD Professor and Chair Department of Surgery Oregon Health Sciences University Crystal Ball, Palm Reading, and Other Facets of Trauma Care or Future Shock
1993 Ward O. Griffen, MD Executive Director, Secretary/Treasurer American Board of Surgery Amuart, Amuart, Amuart
1994 Charles C. Wolferth, MD Emilie & Roland T. de Hellebranth Professor of Surgery University of Pennsylvania School of Medicine Trauma Centers and Trauma Systems in 1994 – Where Are We?
1995 Kenneth L. Mattox, MD Baylor College of Medicine …And Then There Were None
1996 Basil A. Pruitt, Jr., MD Editor, Journal of Trauma The Synergism of Integrated Clinical/Laboratory Research
1997 Norman Rich, MD Professor and Chairman, Uniformed Services University of the Health Sciences Military Surgical Impact on Vascular Trauma 1998 David Hoyt, MD The Monroe E. Trout Professor of Surgery Chief, Division of Trauma University of California San Diego Guidelines and Outcomes: What Should We Do?
1999 James Carrico, MD Professor and Chairman Department of Surgery University of Texas Southwestern Medical Center Care of the Injured: Where Are We? Where Are We Going?
2000 Richard L. Judd, PhD President, Central Connecticut State University Professor, Emergency Medical Services History of Emergency Medical Care
2001 J. David Richardson, MD Vice-Chairman Department of Surgery University of Louisville School of Medicine Evolution in the Management of Hepatic Trauma
2002 Katherine Christoffel, MD, MPH Director, Statistical Sciences and Epidemiology Program Medical Director, Violent Injury Prevention Center Division of General Academic Pediatrics Children’s Memorial Hospital Gun Injury Prevention Comes of Age
SCOTT B. FRAME, MD MEMORIAL LECTURE
2003 Charles L. Rice, MD, FACS Vice Chancellor for Health Affairs Professor of Surgery and Physiology/Biophysics Chair, ACGME University of Illinois at Chicago Trauma Care and the Patient Safety Imperative
2004 Donald D. Trunkey, MD, FACS Professor of Surgery Past Chairman, Department of Surgery Oregon Health and Science University Maintaining the Nobel Effort
2005 Steven R. Shackford, MD University of Vermont The Future of Trauma Surgery SCOTT B. FRAME, MD MEMORIAL LECTURE OF THE EAST FOUNDATION
2006 L. D. Britt, MD Eastern Virginia Medical School The Critical Analysis: What We Have Done Right and What We Have Done Wrong
2007 Thomas Russell, MD, FACS Executive Director, American College of Surgeons
2008 Gregory J. Jurkovich, MD, FACS University of Washington School of Medicine Acute Care Surgery: Building a New Specialty
2009 Will Chapleau, EMT-P, RN, TNS Manager, ATLS Program, American College of Surgeons The Emergency Care Team: Two Steps Forward or One Step Backward?
2010 Howard Champion, MD, FRCS, FACS EAST President 1991 Trauma on the Hill
2011 David B. Hoyt, MD, FACS Executive Director, American College of Surgeons Damage Control Resuscitation – The Historical Perspective
2012 Richard Carmona, MD, MPH, FACS 17th Surgeon General of the United States (2002-2006) The Trauma of Politics: A Surgeon General’s Perspective
GENERAL MOORS AWARD RECIPIENT
1991 Steven Stylianos, MD Non-Effect of Experimental Hemorrhage and Blunt Trauma on Circulating TNF
1992 Ellen J. Mackenzie, PhD Inter-rater Reliability of Preventable Death Judgments
1993 Joseph Schmoker, MD Effect of Lesion Volume on Cerebral Blood Flow After Focal Brain Injury and Shock
1994 Martin Croce, MD Analysis of Charges Associated with Diagnosis of Nosocomial Pneumonia: Can Routine Bronchoscopy Be Justified?
1995 Heidi Frankel, MD Diaspirin Cross Linked Hemoglobin Is Efficacious in Gut Resuscitation as Measured by GI Tract Optode
BEST MANUSCRIPT AWARD RECIPIENT
1997 Daniel Herron, MD How Hot Can Blood Get? Maximally Heating Blood with an Inline Microwave Blood Warmer
1998 David Burris, MD Controlled Resuscitation for Uncontrolled Hemorrhagic Shock
1999 Lawrence N. Diebel, MD Synergistic Effects of Candida and E. Coli on Gut Barrier Function
2000 Mark A. Healey, MD Irreversible Shock Is Not Irreversible: A New Model of Massive Hemorrhage and Resuscitation
2001 Steven N. Vaslef, MD, PhD Oxygen Transport Dynamics of Acellular Hemoglobin Solutions in an Isovolemic Hemodilution (IVH) Model in Swine
2002 Robert A. Cherry, MD Accuracy of Short-Duration Creatinine Clearance (CRCI) Determinations in Predicting 24-Hour CRCI in Critically Ill and Injured Patients
2003 Saber Ghiassi Methylene Blue Enhances Resuscitation After Refractory Hemorrhagic Shock
2004 Wenjun Z. Martini, PhD Independent Contributions of Hypothermia and Acidosis to Coagulopathy
2005 Vicente Mejia, MD Plain Films vs. Helical CT for Thoracolumbar Spine Clearance
2006 Wenjun Z. Martini, PhD Does Bicarbonate Correct Coagulation Function Impaired by Acidosis in Swine?
2007 Michael Englehart, MD Ketamine-Based Total Intravenous Anesthesia is Superior to Isoflurane in a Swine Model of Hemorrhagic Shock
2008 Michael Englehart, MD A Novel, Highly Porous Silica and Chitosan Based Hemostatic Dressing Is Superior to Hemcon and Gauze Sponges
2009 Tania K. Arora, MD L-Arginine Infusion During Resuscitation for Hemorrhagic Shock: Impact and Mechanism
2010 Brendan Carr, MD, MS Does the Trauma System Protect Against the Weekend Effect?
2011 João B. Rezende-Neto, MD, PhD Permissive Hypotension Does Not Reduce Regional Organ Perfusion Compared to Normotensive Resuscitation: Animal Study with Fluorescent Microspheres
2012 Joshua B. Brown, MD Debunking the Survival Bias Myth: Characterization of Mortality over the Initial 24 Hours for Patients Requiring Massive Transfusion
RAYMOND H. ALEXANDER, MD AWARD RECIPIENT
1993 Ian Hamilton, MD Diaspirin Cross Linked Hemoglobin (DCLHb) Is Superior to Lactated Ringers Solution, Haemaccel, and Blood Restoring Base Excess in Rats Resuscitated from Severe Hemorrhage
1994 Brian Plaisier, MD Prospective Evaluation of Craniofacial Pressure in Four Different Cervical Orthoses
1995 John Sweeney, MD PMN Function in Injured Adults with Positive Candida Antigen Titers: Intact Autocrine Activation Despite Impaired Candida Killing
1996 Keith Clancy, MD Down Regulation of Tissue Specific TNF-a in the Liver and Lung After Burn Injury and Endotoxinemia
1997 C. S. Hultman, MD Early but Not Late Burn Wound Excision Partially Restores Viral Specific T Lymphocyte Cytotoxicity
1998 Margo C. Shoup, MD Cyclooxygenase-2 Inhibitor (NS-398) Improves Survival and Restores Leukocyte Counts in Burn Infection
1999 Randy J. Woods, MD Hypothermic Aortic Arch Slush for Preservation of Brain and Heart During Prolonged Exsanguination Cardiac Arrest in Dogs
Mary B. Malay, MD Low Dose Vasopressin (VP) in the Treatment of Refractory Septic Shock
2000 Darryl Choo, MD In Vivo Characterization of the Molecular-Genetic Changes in Gastric Mucosa During the Development of Acute Gastritis and Stress Ulceration
2001 Victor B. Kim, MD Methylene Blue (MB) Improves Tissue Perfusion During Class IV Hemorrhagic Shock in Dogs
2002 David C. Cassada, MD Adenosine A2A Analogue Improves Neurologic Outcome After Spinal Cord Trauma in the Rabbit
2003 Mallory Williams, MD The Role of cAMP and cGMP-Dependent Protein Kinase Pathways in Hydrogen Peroxide Induced Contractility of Microvascular Lung Pericytes
2004 Bruce Crookes, MD Can Muscle Near Infrared Spectroscopy (NIR) Identify the Severity of Shock in Trauma Patients?
2005 David R. King, MD Pulmonary Artery Catheters Induce a Systemic Hypercoagulable State
2006 Mayur B. Patel, MD Hemoglobin-Based Oxygen Carrier (HBOC) Use in Neurotrauma Care
RAYMOND H. ALEXANDER, MD RESIDENT PAPER COMPETITION OF THE EAST FOUNDATION
2007 Michael Englehart, MD Ketamine-Based Total Intravenous Anesthesia Is Superior to Isoflurane in a Swine Model of Hemorrhagic Shock
2008 Mark Gunst, MD Accuracy of Cardiac Function and Volume Status Estimates Using the Bedside Echocardiographic Examination in Trauma/Critical
2009 Tania K. Arora, MD L-Arginine Infusion During Resuscitation for Hemorrhagic Shock: Impact and Mechanism
2010 Nicholas Spoerke, MD Red Blood Cells Accelerate the Onset of Clot Formation in Polytrauma and Hemorrhagic Shock
2011 Matthew D. Neal, MD – Award Recipient The Crystalloid/Packed Red Blood Cell Ratio Following Massive Transfusion: When Less Is More
Edward J. Hannoush, MD – Honorable Mention Impact of Enhanced Mobilization of Bone Marrow Derived Cells to Site of Injury
2012 Shreyas K. Roy, MD, CM – Award Recipient Preventative Ventilation Prior to Lung Injury Averts ARDS: A Novel Timing-Based Strategy of Ventilator Therapy
Priya Prakash, MD – Honorable Mention Human Microparticles Generated During Sepsis in Critically Ill Patients Are Neutrophil- Derived and Modulate the Immune Response
JOHN M. TEMPLETON JR., MD INJURY PREVENTION PAPER COMPETITION OF THE EAST FOUNDATION
2007 Kamela Scott, PhD A Focused, Comprehensive Adolescent Violence Intervention Program Is Both Sustained and Enhanced over Prevention that Works: The Effect of Time
2008 Greg Stadter, BA The Effects of Side Impact Air Bags on Injury Mitigation
2009 Peter Ehrlich, MD, MSC Alcohol Interventions for Trauma Patients Are Not Just For Adults: Justification for Brief Interventions for the Injured Adolescent at a Pediatric Trauma Unit
2010 Melissa R. Hoffman, MD Bicycle Commuter Injury Prevention: It’s Time to Focus on the Environment
2011 Thomas Z. Hayward, MD Traffic Infraction Patters Before and After Trauma Center Admission Compared to Brief Courtroom Intervention
2012 Jason W. Smith, MD A Targeted Arson Prevention Program Greatly Reduces Recidivism
JOHN M. TEMPLETON JR., MD INJURY PREVENTION RESEARCH SCHOLARSHIP OF THE EAST FOUNDATION
2009 Michel Aboutanos, MD Bridging the Gap: A Youth Violence Reduction Project
2010 James F. Calland, MD Evaluation of Peer Counselors, Community Resources, and Video Interventions in Preventing Trauma Recidivism
2011 Lisa C. Allee, LICSW Evaluating Three Methods to Encourage Mentally Competent Older Adults to Assess Their Driving Skills
2012 Karen Lommel, DO, MHA, MS Blazing New Trails in Injury Prevention: An Interactive ATV Safety Education Program
EAST/WYETH-AYERST RESEARCH SCHOLARSHIP RECIPIENT
2002 John M. Santaniello, MD Bone Marrow Response to the Burn/Sepsis Model
2003 Alicia M. Mohr, MD Beta Adrenergic Modulation of Erythropoiesis in Trauma
2004 John A. Sandoval, MD The Evaluation of an Anti-Peptidoglycan Monoclonal Antibody for the Diagnosis of Bacterial Sepsis: A Pathway to a Quicker Diagnosis?
2005 Daniel E. Carney, MD Attenuation of Adult Respiratory Distress Syndrome with a Modified Tetracycline Compound
TRAUMA RESEARCH SCHOLARSHIP OF THE EAST FOUNDATION Financially Supported by Wyeth (2006-2010) Financially Supported by Pfizer, Inc. (2011) Financially Supported by KCI & LifeCell (2012)
2006 Bruce A. Crookes, MD Permissive Hypercarbia During Acute Resuscitation After Traumatic Brain Injury
2007 Andrew C. Bernard, MD Transfusion and T-Cell Receptor Expression
2008 Samuel Mandell, MD The National Impact of Vehicle Mismatch on Mortality After Motor Vehicle Crashes
2009 Jordan A. Weinberg, MD RBC Storage Age and Potentiation of Transfusion-Related Clinicopathology in Trauma Patients
2010 Jason W. Smith, MD Direct Peritoneal Resuscitation Effects in the Damage Control Trauma Patient
2011 Martin D. Zielinski, MD The Biomechanical Effects of Flaccid Paralysis Induced by Botulinum Toxin A After Damage Control Laparotomy: A Randomized Clinical Trial
2012 Jeremy J. Heffner, MD Mesenchymal Stem Cell and Platelet-Rich Plasma Therapy using a Porcine Small Intestine Submucosa Delivery System for Treatment of Burn Wounds BRANDEIS UNIVERSITY LEADERSHIP CONFERENCE IN HEALTH POLICY AND MANAGEMENT SCHOLARSHIP OF THE EAST FOUNDATION Financially Supported by The Dorothy K. Commandy Foundation and Edward Yelon
2010 A. Britton Christmas, MD
2011 Elliott Haut, MD
2012 John Como, MD
SOCIETY OF TRAUMA NURESES – EAST FOUNDATION NURSE FELLOWSHIP
2011 Amber Kyle, BS, BSN
2012 Katherine Heldt, BSN, RN
HONORARY MEMBERS
Richard Carmona, MD, MPH Tucson, AZ C. James Carrico, MD Dallas, TX Will P. Chapleau, EMT-P, RN, TNS Chicago, IL Katherine K. Christoffel, MD MPH Chicago, IL John H. Davis, MD Burlington, VT James H. Duke Jr., MD Houston, TX John J. Fildes, MD Las Vegas, NV Joyce Frame Cincinnati, OH Donald E. Frye, MD Albuquerque, NM Ward O. Griffen, MD Lexington, KY J. Alex Haller, MD Glencoe, MD David B. Hoyt, MD Chicago, IL Richard Judd, MD New Brittan, CT Gregory J. Jurkovich, MD Seattle, WA Kenneth L. Mattox, MD Houston, TX Ernest E. Moore, MD Denver, CO Francis D. Moore, MD Boston, MA Basil A. Pruitt, Jr. MD San Antonio, TX Jonathan E. Rhodes, MD Philadelphia, PA Charles L. Rice, MD Chicago, IL Norman Rich, MD Bethesda, MD H. David Root, MD San Antonio, TX Gerald Shaftan, MD Brooklyn, NY Cuthbert O. Simpkins, II, MD Shreveport, LA Erwin Thal, MD Dallas, TX Donald D. Trunkey, MD Portland, OR G. Girish Chandra Varma Birmingham, AL Charles C. Wolferth, MD Philadelphia, PA
The EAST Presidential Gavel Box
In 2006, Michael F. Rotondo, MD, FACS, 18th President of the Association, commissioned Paul Gianino, a master cabinet maker from Greenville, North Carolina to create a box for the presidential gavel of the Eastern Association for the Surgery of Trauma (EAST). To this point, the gavel had been housed in a forest green, fleece drawstring bag. At the writing of this, there was no institutional memory regarding the origin of the fleece bag. Upon receiving the gavel at the start of his presidency in 2005, Rotondo found this curious and decided to commission the design and construction of a more permanent home for the gavel.
Gianino, originally from Boston, Massachusetts, is a modern master taught exclusively by his father. He is nationally recognized as one of America’s most talented cabinet makers. He has extensive experience building such boxes for judges, heads of council, and other leaders across the country. Under Dr. Rotondo’s guidance, he designed the box to hallmark both the organization as well as the time in which the box was constructed.
The box is made from 19th century Honduran mahogany with over 100 separate hand made parts. The top features the rising sun of EAST inlaid with burled elm on a background of Cuban mahogany framed in a rectangular band of holly. The sides of the box feature hand-crafted, raised panels. The cover of the box is attached with geometric, gold-plated stop hinges from the 1860’s. So that the gavel may be displayed with the cover open, an engraved, sterling silver plate with the EAST insignia and the words, “The Presidential Gavel”, was applied to the inside cover, and an internal, glass dust cover was hinged into the box in a hand-crafted frame. Even the inside cover of the frame for the glass has original, detailed, beveled molding to hold it in place. The gavel and sound block sit in felt-covered custom cradles. No traditional stains were used in the development of the piece but rather a series of acid washes applied in such a fashion that the darkness and richness of the wood is maximized. The finish is in simple shellac.
In an effort to hallmark the piece to the time and to EAST’s commitment to the care of our wounded warriors, Dr. Rotondo asked Col. Donald H. Jenkins, United States Air Force and Joint Theater Trauma System Chief in the Iraq War at the time, to supply some remembrance of the conflict to incorporate into the design of the gavel box. Col. Jenkins was serving on the EAST Board of Directors as Chairman of the Ad Hoc Military Committee. After a 210-day deployment throughout most of 2006, Col. Jenkins returned with an SOF Technical Tourniquet used on a 22 year old United States Marine whose life was saved as a result of application of the device and subsequent operation by Commander Tracy R. Bilski, United States Navy and a member of EAST. In fact, a number of EAST members deployed at the time cared for this young marine throughout the echelons of care. The tourniquet was incorporated into the box by utilizing the aluminum rotation bar (twister) as a cover handle, secured in place with a hand turned mahogany knob. Upon close examination of the handle, one can still see evidence of the Marine’s dried blood encrusted in the grooves of the twister. A piece of the tourniquet’s nylon strap was used to secure the gavel in its cradle, and the tourniquet label was preserved to authenticate the piece.
The box was presented as a gift to the organization by Dr. Rotondo to Michael Pasquale, MD, FACS, FCCM, 19th President of the Association, on the occasion of the gavel exchange to Kimberly Nagy, MD, FACS, 20th and first woman President of the Association, at the Annual Scientific Assembly in 2007.
The History of the EAST Gavel Box
The following speech was given at the 2007 Annual Scientific Assembly of EAST by Col. Donald Jenkins, MD
I was asked by President Rotondo to make a brief presentation of a significance which will become apparent shortly. Yesterday, I was surprised to discover that 5% of Active EAST members have been deployed to war in Iraq/Afghanistan in the past year alone. But, let me share with you a story of a 22 year old Lance Corporal in the USMC who was injured in October 2006 during operations near Al Taqqadam, Iraq, about 30 miles west of Baghdad in Al Anbar Province, between Fallujah and Ramadi. During a firefight, he sustained both upper and lower extremity gunshot wounds. A Navy Corpsman applied a SOF-T tourniquet on his leg due to massive hemorrhage, and he was taken to the US Navy Forward Resuscitative Surgical site in Al Taqqadam, a.k.a., TQ Surgical. There, CDR Tracy Bilski, US Navy and EAST member, performed life and limb salvage surgery, to include vascular shunt of his femoral artery. The patient was then evacuated to the Air Force Theater Hospital in Balad, Iraq, where further resuscitation and salvage surgery were performed, and definitive vascular repair was accomplished. Upon entry at Balad, Maj. Michelle Park, USAF and a prospective EAST member, oversaw his surgical and critical care.
His presenting blood pressure was 100/62, BD 7, INR 1.6, and Hgb 7 – all independent risk factors for massive transfusion and associated with a 40% mortality. Overall, he received eleven units PRBC, eight units cryo, one 6-pack of platelets, five units of plasma, and five units of whole blood in addition to four doses of recombinant fVIIa.
After this stabilizing surgery, he remained critically ill and ventilator dependent but was flown by Air Force Critical Care Air Transport Team (trained before their deployment by Col. Jay Johannigman, USAF and EAST member and Maj. Stephen Barnes, USAF and prospective EAST member) to Landstuhl Regional Medical Center in Germany, where Col. Warren Dorlac, USAF and EAST member, assumed his care. This Military Trauma Center is run by Col. Stephen Flaherty, USA and EAST member; the Trauma Program Manager is Ms. Kathie Martin, EAST Associate Member. After several days of critical care and serial wound washouts, during which visiting Senior Surgeon Dr. Donald Trunkey, former USA surgeon and Honorary EAST member, participated in his care, thanks to a program spearheaded by Bill Schwab, formerly US Navy and Past President of EAST, this Marine was extubated and transferred to Bethesda National Naval Medical Center to the care of CDR Jim Dunne and Capt. Phil Perdue, US Navy and EAST members. He is now recovering as an outpatient at Camp Pendleton, California.
The care of this Lance Corporal is perhaps the quintessential case of modern combat casualty care and highlights the participation of EAST members in the military: casualty care in echelons; use of tourniquets by field medics; far forward damage control surgery, including the use of vascular shunts; definitive vascular repair in-theater; use of ‘damage control resuscitation’ (to include ultra-fresh whole blood, PRBC:plasma in 1:1 ratio, use of platelet pheresis platelets collected in combat zone, and use of rVIIa), then; CCATT transport out of theater; and rapid transition to care in the continental United States across the continuum of care with multiple surgeries along the way. These protocols, procedures, and guidelines have been drafted, published, implemented, and refined over the last several years with significant input and oversight from EAST members to include, Capt. Peter Rhee, USN, Col. John Holcomb, USA, Col. David Burris, USA, Col. Brian Eastridge, USA, Col. Stephen Flaherty, USA and Col. Donald Jenkins, USAF. At every stop, EAST members had a vital role in his care. The SOF-T tourniquet ‘built in’ to the Presidential Gavel box was used on this Marine.
Scott B. Frame, MD Memorial Lectureship of the EAST Foundation
Scott Barnhart Frame, MD personified the Eastern Association for the Surgery of Trauma (EAST). He was young, energetic, and an enthusiastic mentor for medical students, surgical residents, and his peers. He fought for well-developed, comprehensive systems of trauma care, and he believed the disease of trauma did have solutions that could improve its outcome.
Scott Frame was born on January 31, 1952 in Portsmouth, Virginia. However, he grew up in Albuquerque, New Mexico, graduating from high school in 1970 and then attending the University of New Mexico for both his undergraduate training and medical school. He received his MD degree in 1980 from the University of New Mexico and spent the next ten years of his life on active duty in the Navy. He returned to Portsmouth, Virginia for his internship and residency in general surgery, completing that training in 1986. He did a fellowship in Trauma and Critical Care with Dr. Norman McSwain at Tulane in New Orleans, Louisiana (1987-1988). He completed two operational tours in the Navy – the first on the USS Raleigh as a general medical officer and the second on the USS Theodore Roosevelt (CVN-71), serving as the general surgeon on her commissioning crew, making him a “plankowner” of the Roosevelt. He completed his naval service at the Naval Hospital in San Diego, California.
In August 1990, Dr. Frame joined the faculty at the University of Tennessee Medical Center in Knoxville, Tennessee as an Assistant Professor of Surgery. He remained there for seven years, serving as the Director of the Trauma Service and the Director of Surgical Endoscopy while advancing to Associate Professor of Surgery with tenure. He also worked closely with pre- hospital providers and Lifestar Aeromedical Services. In October 1997, he resigned from the university to accept a position with the University of Cincinnati as Full Professor of Surgery and Director of the Division of Trauma/Critical Care in the Department of Surgery. He remained in this position until his untimely death from colon cancer in March 2001 at the age of 49.
Dr. Frame was known as a superb technical surgeon who would do anything necessary to save his injured patient but also had the judgment required to know when not to operate. He believed all patients needed to be treated the same, to prevent making mistakes. He was an excellent teacher and mentor, winning teaching awards in every program he served. He expected those he taught would be as passionate about surgery and trauma as he was himself. He was loyal to those with whom he worked and respected, and he was always honest. He would take strong positions and argue for them, but he would also consider opposing points of view. If the logic of the opposition proved correct, he would readily admit he was wrong.
Dr. Frame was very active in the early days of EAST. He was a charter member of the organization and served in many ways. He was on the Membership Committee and the Program Committee, playing an active role as they helped establish the reputation of EAST and powered its early growth. He was actively involved in the scientific program at EAST, submitting abstracts and manuscripts to the program and encouraging his residents and fellows to do the same. He and his wife, Joyce, attended every annual meeting of EAST that was held until he became too ill from his cancer to attend.
Dr. Frame’s contributions to the scientific literature in trauma were extensive and continued right up to the time of his death. Besides many important articles on trauma, Dr. Frame edited a book on Retroperitoneal Trauma with Dr. McSwain. At the time of his death, Dr. Frame was again serving with Dr. McSwain as Editor of the Fifth Edition of the PHTLS training manual. Dr. Frame served as the Associate Medical Director of PHTLS beginning in 1994, continuing and expanding his long interest in pre-hospital care and taking the course around the world. He had accepted the position of Medical Director of PHTLS, to be assumed at the time of publication of the Fifth Edition of the training manual.
Dr. Frame was a mentor, an inspiration, and a friend to many of the early leaders and members of EAST. He and his wife, Joyce, were always together at meetings and at home and always ready to serve the trauma community in anyway they could. Joyce has continued to serve EAST in supporting this lectureship in Scott’s name to ensure his memory and his contributions to trauma care live on. As his good friend and mentor, Dr. McSwain said, Scott Frame “embodied the trauma surgeon – outspoken when he believed that he was correct, loving when he was needed, aggressive in the care of his patients, and an excellent teacher to residents, other physicians, and to the pre-hospital providers of the world.”
The Raymond H. Alexander, MD Resident Paper Competition of the EAST Foundation
Raymond H. Alexander, MD received his undergraduate degree from Princeton University and his MD from Duke University. Following military service to the country, he moved to Jacksonville, Florida as one of the first board certified vascular surgeons in the state.
Dr. Alexander was Medical Director of the trauma program and Chief of Surgery at the University of Florida Health Science Center in Jacksonville. He also served as Medical Director of Florida's Emergency Medical Services Office. His accomplishments included fostering a statewide trauma system before his untimely death to cancer in 1992.
In addition to the EAST Foundation Resident Paper Competition, several other awards and honors bear his name, a testament to his impact on trauma care. The Raymond H. Alexander Medical Director of the Year is given by the Florida Department of Health’s Bureau of Emergency Medical Services (EMS) to a physician who assumed a leadership role in EMS with the community or nationally and demonstrates excellence in the areas of quality assurance/ improvement and medical control, as well as the promotion and use of new medical trends and technologies. The American College of Surgeons Florida Chapter annually presents the Raymond H. Alexander, MD Award to a surgeon for outstanding dedication and service to the medical profession in the field of surgery, as exemplified by the devoted and unselfish life of Dr. Alexander. The Florida Committee on Trauma holds the Annual Raymond Alexander Visiting Professor, a traveling series of grand rounds lectures by a national expert who visits trauma centers across the state over one week.
Dr. Alexander was one of ten surgeons recognized as a Founding Board Member of EAST.
His lifelong dedication to organized care for the injured is an inspiration to the membership and friends of EAST. The Annual Resident Paper Competition of the EAST Foundation, which is held during the Annual Scientific Assembly, is named in his honor.
bylaws
BYLAWS OF THE EASTERN ASSOCIATION FOR THE SURGERY OF TRAUMA
AMENDED JANUARY 2012
ARTICLE 1. MEMBERSHIP
SECTION 1. THERE SHALL BE EIGHT (8) CLASSES OF MEMBERSHIP IN THE ASSOCIATION: ACTIVE, SENIOR, STUDENT, PROVISIONAL, ASSOCIATE, INTERNATIONAL-CORRESPONDING, HONORARY, AND EMERITUS.
SECTION 2. ELECTION TO AND MEMBERSHIP IN THE ASSOCIATION IS CONTINGENT UPON GOOD MORAL CHARACTER. MEMBERSHIP IN THE ASSOCIATION IS A PRIVILEGE CONTINGENT UPON CONTINUING COMPLIANCE WITH THE BYLAWS OF THE ASSOCIATION.
SECTION 3. ELECTION OF ACTIVE, SENIOR, PROVISIONAL, ASSOCIATE, INTERNATIONAL- CORRESPONDING, AND EMERITUS MEMBERS.
SECTION 3.1. THE FOUNDING MEMBERS OF EAST WERE DRS. KIMBALL I. MAULL, BURTON H. HARRIS, LENWORTH M. JACOBS, AND HOWARD R. CHAMPION. THE ORIGINAL EAST BOARD OF DIRECTORS WAS DRS. C. WILLIAM SCHWAB, MICHAEL RHODES, RAY ALEXANDER, ANDREW BURGESS, THOMAS GENNARELLI, AND NORMAN E. MCSWAIN. A LIST OF CHARTER MEMBERS WAS ESTABLISHED AND CLOSED APRIL 24, 1987.
SECTION 3.2. ACTIVE, SENIOR, PROVISIONAL, ASSOCIATE, INTERNATIONAL-CORRESPONDING, AND EMERITUS MEMBERS SHALL BE ELECTED BY THE MEMBERSHIP FROM THE NOMINATIONS BY THE BOARD OF DIRECTORS. A THREE-QUARTERS (3/4) AFFIRMATIVE VOTE OF THE VOTING MEMBERS PRESENT SHALL BE REQUIRED FOR ELECTION.
SECTION 3.3. PERSONS QUALIFIED FOR ACTIVE, SENIOR, PROVISIONAL, STUDENT, ASSOCIATE, OR INTERNATIONAL-CORRESPONDING MEMBERSHIP MUST INITIATE THE APPLICATION PROCESS VIA THE SUBMISSION OF AN APPLICATION TO THE CHAIRPERSON OF THE MEMBERSHIP COMMITTEE VIA THE CENTRAL OFFICE.
SECTION 3.4. TO APPLY FOR MEMBERSHIP, AN INDIVIDUAL MUST COMPLETE THE STANDARD APPLICATION, WHICH INCLUDES SUBMITTING A CURRICULUM VITA. AN APPLICATION FEE, IN AN AMOUNT DETERMINED BY THE BOARD OF DIRECTORS, MUST BE RECEIVED PRIOR TO CONSIDERATION OF THE APPLICATION. SPONSORING LETTERS FOR EACH CLASS OF MEMBERSHIP ARE REQUIRED. THE MEMBERSHIP COMMITTEE, WITH SUBSEQUENT APPROVAL FROM THE BOARD OF DIRECTORS, DETERMINES PROCEDURES FOR APPLICATION PROCESSING.
SECTION 3.5. THE MEMBERSHIP COMMITTEE SHALL CONSIDER ALL APPLICATIONS AND MAKE A RECOMMENDATION TO THE BOARD OF DIRECTORS ON WHICH CANDIDATES ARE ELIGIBLE FOR ACTIVE, SENIOR, STUDENT, PROVISIONAL, ASSOCIATE, EMERITUS, OR INTERNATIONAL- CORRESPONDING MEMBERSHIP.
SECTION 3.6. THE BOARD OF DIRECTORS SHALL REVIEW THE RECOMMENDATION OF THE MEMBERSHIP COMMITTEE AND SHALL MAKE NOMINATIONS FOR ACTIVE, SENIOR, STUDENT, PROVISIONAL, ASSOCIATE, EMERITUS, AND INTERNATIONAL-CORRESPONDING MEMBERSHIP AT THE ANNUAL GENERAL MEETING.
SECTION 4. ELECTION TO HONORARY MEMBERSHIP.
SECTION 4.1. THE BOARD OF DIRECTORS SHALL MAKE NOMINATIONS, IF ANY, FOR HONORARY MEMBERSHIP AT THE ANNUAL GENERAL MEETING. HONORARY MEMBERS SHALL BE ELECTED FROM THE NOMINATIONS OF THE BOARD OF DIRECTORS BY A THREE-QUARTERS (3/4) VOTE OF THE VOTING MEMBERS PRESENT.
SECTION 5. NEW MEMBERS.
SECTION 5.1. MEMBERSHIP FOR NEW MEMBERS WILL BECOME EFFECTIVE THE DAY FOLLOWING THEIR ELECTION, WITH THE FULL PRIVILEGES OF THEIR CLASS OF MEMBERSHIP.
SECTION 6. ACTIVE MEMBERS.
SECTION 6.1. QUALIFICATION FOR ACTIVE MEMBERSHIP REQUIRES THAT AN APPLICANT BE: (A) A LICENSED PHYSICIAN. (B) ACTIVE IN THE FIELD OF TRAUMA OR HAS MADE WORTHWHILE, SCIENTIFIC CONTRIBUTIONS IN THE FIELD OF TRAUMA. (C) RESIDING IN THE UNITED STATES AND ITS TERRITORIES, OR IN CANADA. (D) IN POSSESSION OF A VALID CERTIFICATE FROM A SURGICAL BOARD, WHICH IS A MEMBER OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES OR THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA.
SECTION 6.2. ANY OF THE REQUIREMENTS IN ARTICLE 1, SECTION 6.1 MAY BE WAIVED BY THE BOARD OF DIRECTORS UNDER EXCEPTIONAL CIRCUMSTANCES.
SECTION 6.3. ACTIVE MEMBERS IN GOOD STANDING WITH THE ORGANIZATION MAY VOTE, HOLD OFFICE, ATTEND BUSINESS MEETINGS, AND SERVE ON COMMITTEES.
SECTION 6.4. ACTIVE MEMBERS SHALL PAY DUES ASSESSMENTS AND MEETING REGISTRATION FEES AS DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 7. SENIOR MEMBERS.
SECTION 7.1. ACTIVE MEMBERS, UPON REACHING THE AGE OF FIFTY (50), WILL BECOME SENIOR MEMBERS. INDIVIDUALS MAY APPLY FOR SENIOR MEMBERSHIP SUBJECT TO THE SAME ELECTION CRITERIA (EXCEPT FOR HOLDING OFFICE) AS ACTIVE AND INTERNATIONAL-CORRESPONDING MEMBERS (SECTIONS 3.1–3.6, 6.1–6.3, AND SECTION 10.1). SUCH MEMBERS WILL PAY AN INITIATION FEE DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 7.2. SENIOR MEMBERS WILL PAY DUES. SENIOR MEMBERS IN GOOD STANDING WITH THE ORGANIZATION MAY ATTEND ALL FUNCTIONS, MAY VOTE, AND MAY SERVE ON COMMITTEES BUT MAY NOT BE ELECTED OR APPOINTED TO OFFICE, UNLESS FULFILLING A PREVIOUS ROLE FOR OFFICE. ONE SENIOR MEMBER SHALL BE APPOINTED BY THE PRESIDENT TO SERVE EX-OFFICIO AS AN ADDITIONAL DIRECTOR-AT-LARGE.
SECTION 8. HONORARY MEMBERS.
SECTION 8.1. HONORARY MEMBERS SHALL BE INDIVIDUALS WHOM THE ASSOCIATION DEEMS WORTHY OF SPECIAL HONOR BECAUSE OF NOTABLE CONTRIBUTIONS TO THE FIELD OF TRAUMA OR BECAUSE OF LONG ACTIVITY IN THE INTEREST OF THE ASSOCIATION.
SECTION 8.2. HONORARY MEMBERS SHALL NOT VOTE, HOLD OFFICE, OR SERVE ON COMMITTEES. THEY MAY ATTEND ALL FUNCTIONS OF THE ASSOCIATION. THEY ARE NOT SUBJECT TO THE ATTENDANCE REQUIREMENT AND ARE NOT REQUIRED TO PAY DUES.
SECTION 8.3. HONORARY MEMBERS SHALL PAY A REGISTRATION FEE IN AN AMOUNT DETERMINED BY THE BOARD OF DIRECTORS FOR MEETINGS THEY ATTEND.
SECTION 9. ASSOCIATE MEMBERS.
SECTION 9.1. PHYSICIANS IN NON-SURGICAL SPECIALTIES AND NON-PHYSICIANS MAY APPLY FOR ASSOCIATE MEMBERSHIP. CANDIDATES ARE QUALIFIED TO BECOME ASSOCIATE MEMBERS IF THEY: (A) ARE CERTIFIED IN THEIR SPECIALTY OR DISCIPLINE IF SUCH CERTIFICATION EXISTS. (B) ARE ACTIVE IN THE FIELD OF TRAUMA OR HAVE MADE WORTHWHILE SCIENTIFIC CONTRIBUTIONS IN THE FIELD OF TRAUMA. (C) RESIDE IN THE UNITED STATES AND ITS TERRITORIES, OR IN CANADA.
SECTION 9.2. NO NEW ASSOCIATE MEMBER CAN BE ADMITTED WHEN THE TOTAL NUMBER OF ASSOCIATE MEMBERS EXCEEDS TWENTY PERCENT (20%) OF THE TOTAL ACTIVE MEMBERSHIP.
SECTION 9.3. ASSOCIATE MEMBERS MAY NOT HOLD OFFICE. ASSOCIATE MEMBERS IN GOOD STANDING WITH THE ORGANIZATION MAY VOTE, MAY ATTEND ALL FUNCTIONS, AND SERVE ON SELECT COMMITTEES AS NOTED IN ARTICLE 4.
SECTION 9.4. ASSOCIATE MEMBERS SHALL PAY DUES ASSESSMENTS AND MEETING REGISTRATION FEES AS DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 10. INTERNATIONAL-CORRESPONDING MEMBERS.
SECTION 10.1. PERSONS ARE QUALIFIED TO BE INTERNATIONAL-CORRESPONDING MEMBERS IF THEY: (A) HAVE CONTRIBUTED SIGNIFICANTLY TO THE UNDERSTANDING OF TRAUMA, ALTHOUGH THEY NEED NOT BE ACTIVELY ENGAGED IN THE PRACTICE. (B) RESIDE IN A COUNTRY OTHER THAN THE UNITED STATES OR CANADA. (C) HAVE ATTENDED AT LEAST ONE (1) ANNUAL MEETING OF THIS ASSOCIATION.
SECTION 10.2. INTERNATIONAL-CORRESPONDING MEMBERS SHALL NOT VOTE, HOLD OFFICE, OR SERVE ON COMMITTEES. THEY MAY ATTEND ALL FUNCTIONS OF THE ASSOCIATION.
SECTION 10.3. INTERNATIONAL-CORRESPONDING MEMBERS SHALL PAY AN INITIATION FEE AS DEFINED BY THE BOARD OF DIRECTORS BUT SHALL NOT BE REQUIRED TO PAY ANNUAL DUES AND ASSESSMENTS. THEY SHALL PAY A REGISTRATION FEE IN AN AMOUNT DETERMINED BY THE BOARD OF DIRECTORS FOR MEETINGS THEY ATTEND.
SECTION 11. PROVISIONAL MEMBERS.
SECTION 11.1. INDIVIDUALS ARE QUALIFIED FOR PROVISIONAL MEMBERSHIP IF THEY MEET ALL THE REQUIREMENTS FOR ACTIVE MEMBERSHIP IN ARTICLE 1, SECTIONS 6.1–6.3, EXCEPT FOR BOARD/ROYAL COLLEGE CERTIFICATION.
SECTION 11.2. THE BOARD OF DIRECTORS SHALL CONSIDER A PROVISIONAL MEMBER FOR ACTIVE MEMBERSHIP WHEN DOCUMENTATION OF BOARD/ROYAL COLLEGE CERTIFICATION IS SUBMITTED TO THE CHAIRPERSON OF THE MEMBERSHIP COMMITTEE VIA THE EAST CENTRAL OFFICE, ALONG WITH A LETTER REQUESTING A CHANGE IN MEMBERSHIP CATEGORY.
SECTION 11.3. PROVISIONAL MEMBERSHIP MAY ONLY BE HELD FOR SEVEN (7) YEARS. PROVISIONAL MEMBERSHIP WILL TERMINATE IF THE MEMBER FAILS TO QUALIFY FOR OR APPLY FOR ACTIVE MEMBERSHIP, UNLESS AN APPEAL TO THE BOARD OF DIRECTORS IS SUBMITTED AND APPROVED BY MAJORITY VOTE.
SECTION 11.4. PROVISIONAL MEMBERS SHALL NOT VOTE OR HOLD OFFICE. THEY MAY ATTEND ALL FUNCTIONS AND SERVE ON SELECT COMMITTEES AS NOTED IN ARTICLE 4.
SECTION 11.5. PROVISIONAL MEMBERS SHALL PAY DUES ASSESSMENTS AND MEETING REGISTRATION FEES AS DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 12. EMERITUS MEMBERS.
SECTION 12.1. A PERSON IS QUALIFIED FOR EMERITUS MEMBERSHIP AFTER BEING ELECTED TO ACTIVE OR SENIOR MEMBERSHIP AND HAVING RETIRED OR BECAME DISABLED AND SUBSEQUENTLY DISCONTINUED INDEFINITELY THE PRACTICE OF MEDICINE.
SECTION 12.2. CANDIDATES FOR EMERITUS MEMBERSHIP WILL HAVE PAID THEIR ASSOCIATION DUES UP TO THE TIME OF THEIR REQUEST FOR EMERITUS STATUS.
SECTION 12.3. EMERITUS MEMBERS SHALL NOT BE REQUIRED TO PAY ANNUAL DUES AND ASSESSMENTS.
SECTION 12.4. EMERITUS MEMBERS SHALL PAY A REGISTRATION FEE IN AN AMOUNT DETERMINED BY THE BOARD OF DIRECTORS FOR MEETINGS THEY ATTEND.
SECTION 12.5. EMERITUS MEMBERS SHALL NOT VOTE, HOLD OFFICE, OR SERVE ON COMMITTEES. THEY MAY ATTEND ALL FUNCTIONS OF THE ASSOCIATION. THEY ARE NOT SUBJECT TO THE ATTENDANCE REQUIREMENT.
SECTION 12.6. RETURN OF AN EMERITUS MEMBER TO ACTIVE/SENIOR STATUS WILL BE THROUGH A REAPPLICATION TO THE MEMBERSHIP COMMITTEE AND APPROVAL OF GENERAL ASSEMBLY AS IT APPLIES TO NEW MEMBERS.
SECTION 13. STUDENT MEMBERS.
SECTION 13.1. INDIVIDUALS ARE QUALIFIED FOR STUDENT MEMBERSHIP IF THEY ARE ENROLLED FULLTIME IN AN ACCREDITED MEDICAL SCHOOL (ALLOPATHIC OR OSTEOPATHIC) LOCATED WITHIN THE UNITED STATES AND ITS TERRITORIES, OR CANADA.
TO INITIATE THE APPLICATION PROCESS, AN INDIVIDUAL SHALL REQUEST AN APPLICATION BY A STATEMENT OF REQUEST TO THE CHAIRPERSON OF THE MEMBERSHIP COMMITTEE VIA THE CENTRAL OFFICE. EACH CANDIDATE FOR STUDENT MEMBERSHIP SHALL SUBMIT THE FOLLOWING BY A DATE AS DESIGNATED BY THE BOARD: (A) A COMPLETE APPLICATION ACCOMPANIED BY ONE (1) SPONSOR’S LETTER FROM AN ACTIVE OR SENIOR MEMBER OF EAST AND A LETTER FROM THEIR MEDICAL SCHOOL DEAN OR OTHER CERTIFYING OFFICIAL. (B) A CURRENT CURRICULUM VITAE INCLUDING A LIST OF PUBLICATIONS AND SCIENTIFIC CONTRIBUTIONS. (C) PAYMENT OF AN APPLICATION FEE AS DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 13.2. THE BOARD OF DIRECTORS SHALL CONSIDER A STUDENT MEMBER FOR PROVISIONAL MEMBERSHIP WHEN DOCUMENTATION OF RESIDENT PHYSICIAN STATUS IS SUBMITTED TO THE MEMBERSHIP COMMITTEE VIA THE CENTRAL OFFICE ALONG WITH A LETTER REQUESTING A CHANGE IN MEMBERSHIP CATEGORY.
SECTION 13.3. STUDENT MEMBERSHIP MAY ONLY BE HELD WHILE IN MEDICAL SCHOOL. STUDENT MEMBERSHIP WILL TERMINATE IF THE MEMBER FAILS TO QUALIFY FOR PROVISIONAL MEMBERSHIP OR APPLY FOR ACTIVE MEMBERSHIP. STUDENT MEMBERSHIP WILL AUTOMATICALLY TERMINATE AFTER FOUR (4) YEARS UNLESS APPEALED AND EXTENDED BY MAJORITY VOTE OF THE BOARD OF DIRECTORS.
SECTION 13.4. STUDENT MEMBERS SHALL NOT VOTE OR HOLD OFFICE. THEY MAY SERVE ON COMMITTEES ONLY AS A NON-VOTING MEMBER. THEY MAY ATTEND ALL OTHER FUNCTIONS.
SECTION 13.5. STUDENT MEMBERS SHALL PAY A NOMINAL DUES ASSESSMENT AS DETERMINED BY THE BOARD OF DIRECTORS AND SHALL PAY REGULAR MEETING REGISTRATION FEES. THEY WILL NOT RECEIVE MAILINGS OR JOURNAL SUBSCRIPTIONS.
SECTION 14. FOR THE PURPOSE OF ESTABLISHING GEOGRAPHIC ELIGIBILITY FOR ACTIVE, SENIOR, STUDENT, PROVISIONAL, OR ASSOCIATE MEMBERSHIP, ACTIVE DUTY MEMBERS OF THE UNIFORMED SERVICES OF THE UNITED STATES OR CANADA SHALL BE DEEMED TO RESIDE IN WASHINGTON, DC OR OTTAWA RESPECTIVELY.
SECTION 14.1. ACTIVE, SENIOR, OR ASSOCIATE MEMBERS WHO MOVE TO A LOCATION BEYOND THE GEOGRAPHIC LIMITS OF THE ASSOCIATION MAY RETAIN THEIR MEMBERSHIP.
ARTICLE 2. OFFICERS
SECTION 1. THE OFFICERS OF THE ASSOCIATION SHALL BE A PRESIDENT, PRESIDENT-ELECT, PAST- PRESIDENT, SECRETARY-TREASURER, AND RECORDER.
SECTION 2. THE PRESIDENT, PRESIDENT-ELECT, AND PAST-PRESIDENT SHALL SERVE A ONE (1) YEAR TERM COMMENCING AT THE CLOSE OF THE ANNUAL GENERAL MEETING DURING WHICH THEY SUCCEEDED OR WERE ELECTED TO OFFICE AND TERMINATING AT THE CLOSE OF THE NEXT FOLLOWING ANNUAL GENERAL MEETING. FOR THE PURPOSES OF AGE RESTRICTIONS AS NOTED IN ARTICLE 1, SECTION 7.1 AND ARTICLE 2, SECTION 3.6, THE OFFICE OF PRESIDENT SHALL BE CONSIDERED A THREE (3) YEAR CONTINUOUS TERM CONSISTING OF THE OFFICES OF PRESIDENT- ELECT, PRESIDENT, AND PAST-PRESIDENT. THE SECRETARY-TREASURER AND THE RECORDER SHALL SERVE TERMS OF THREE (3) YEARS COMMENCING AT THE CLOSE OF THE ANNUAL GENERAL MEETING DURING WHICH THEY SUCCEEDED OR WERE ELECTED TO OFFICE AND TERMINATING AT THE CLOSE OF THE THIRD FOLLOWING ANNUAL GENERAL MEETING.
SECTION 3. ELECTION AND REMOVAL OF OFFICERS.
SECTION 3.1. NO MEMBER SHALL SERVE TWO (2) CONSECUTIVE TERMS IN THE SAME OFFICE, UNLESS ELECTED TO A PARTIAL TERM UNDER THE PROVISION OF ARTICLE 2, SECTION 3.5.
SECTION 3.2. AT THE ANNUAL GENERAL MEETING, THE NOMINATING COMMITTEE SHALL NOMINATE A CANDIDATE FOR EACH OFFICE THAT WOULD OTHERWISE BE VACANT AT THE CLOSE OF THAT MEETING. ADDITIONAL NOMINATIONS MAY BE MADE FROM THE FLOOR.
SECTION 3.3. THE VOTING MEMBERS PRESENT AT THE ANNUAL GENERAL MEETING SHALL ELECT THE OFFICERS FROM AMONG THE NOMINEES BY MAJORITY VOTE.
SECTION 3.4. ANY OFFICER OR APPOINTEE MAY BE REMOVED FROM OFFICE BY A TWO-THIRDS (2/3) VOTE OF THE BOARD OF DIRECTORS WHENEVER, IN ITS JUDGMENT, THE BEST INTERESTS OF THE CORPORATION WOULD BE SERVED THEREBY, BUT SUCH REMOVAL SHALL BE WITHOUT PREJUDICE TO MEMBERSHIP OR CONTRACT RIGHTS, IF ANY, OF THE PERSON SO REMOVED.
SECTION 3.5. IN THE EVENT OF THE DEATH, RESIGNATION, INCAPACITATION, OR REMOVAL OF THE PRESIDENT-ELECT, SECRETARY-TREASURER, OR RECORDER, THE NOMINATING COMMITTEE THAT WAS ELECTED AT THE LAST ANNUAL MEETING SHALL BE RECONVENED TO PROPOSE A NOMINEE FOR THE VACANT OFFICE. THE BOARD OF DIRECTORS WILL ELECT AN ELIGIBLE MEMBER TO SERVE THE REMAINDER OF THE TERM OF THE VACANT OFFICE.
SECTION 3.6. INDIVIDUALS WILL NOT BE NOMINATED AS OFFICERS OR DIRECTORS AFTER THEIR 50TH BIRTHDAY, WITH THE EXCEPTION OF THE DIRECTOR-AT-LARGE SERVING AS THE CHAIRMAN OF THE SENIORS COMMITTEE.
SECTION 4. THE PRESIDENT.
SECTION 4.1. THE PRESIDENT SHALL: (A) PRESIDE AT ALL MEETINGS OF THE ASSOCIATION AND BOARD OF DIRECTORS AND SERVE AS THE EXECUTIVE OFFICER OF THE ASSOCIATION. (B) ESTABLISH AD HOC COMMITTEES NOT OTHERWISE PROVIDED FOR IN THESE BYLAWS SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS AND BE AN EX-OFFICIO MEMBER OF ALL COMMITTEES. (C) MAKE ALL APPOINTMENTS TO COMMITTEES, INCLUDING COMMITTEE CHAIRPERSONS AND VICE-CHAIRPERSONS, AND FILL ALL VACANCIES THAT OCCUR ON COMMITTEES BETWEEN ANNUAL MEETINGS OF THE ASSOCIATION UNLESS OTHERWISE PROVIDED FOR IN THESE BYLAWS. (D) MAKE PROVISIONS FOR NOTIFICATION OF MEMBERS OF APPOINTMENTS TO COMMITTEES. (E) DELIVER AN ADDRESS AT THE ANNUAL GENERAL MEETING. (F) ACT FOR THE ASSOCIATION IN THE EVENT OF ANY CONTINGENCY NOT COVERED BY THE BYLAWS.
SECTION 5. THE PRESIDENT-ELECT AND PAST-PRESIDENT.
SECTION 5.1. THE PRESIDENT-ELECT SHALL PRESIDE AT MEETINGS OF THE ASSOCIATION AND THE BOARD OF DIRECTORS IN THE ABSENCE OF THE PRESIDENT AND SHALL SUCCEED TO THE PRESIDENCY AT THE CLOSE OF THE ANNUAL GENERAL MEETING THE YEAR FOLLOWING ELECTION TO THE OFFICE OF PRESIDENT-ELECT. IN THE EVENT OF DEATH, RESIGNATION, OR INCAPACITATION OF THE PRESIDENT, THE PRESIDENT-ELECT WILL SUCCEED TO THE PRESIDENCY, COMPLETE THE VACANT TERM, AND REMAIN IN OFFICE FOR THE TERM TO WHICH HE/SHE WAS ELECTED.
SECTION 5.2. THE PAST-PRESIDENT SHALL PRESIDE AT MEETINGS IN THE ABSENCE OF THE PRESIDENT AND PRESIDENT-ELECT. SHOULD THE PAST-PRESIDENT BE UNABLE TO SERVE, ANY OTHER PREVIOUS PAST-PRESIDENT MAY SERVE HIS/HER TERM UPON NOMINATION BY THE NOMINATING COMMITTEE AND CONFIRMATION BY MAJORITY VOTE OF THE BOARD OF DIRECTORS.
SECTION 6. THE SECRETARY-TREASURER SHALL: (A) CARRY ON ALL OFFICIAL CORRESPONDENCE OF THE ASSOCIATION AND KEEP A RECORD OF THE PROCEEDINGS OF ALL ASSOCIATION MEETINGS AND MEETINGS OF THE BOARD OF DIRECTORS. (B) KEEP A ROSTER OF MEMBERS OF THE ASSOCIATION AND AN ATTENDANCE RECORD OF MEMBERS AND GUESTS AT ANNUAL MEETINGS. (C) PROVIDE AN ANNUAL REPORT TO THE BOARD OF DIRECTORS. (D) PROVIDE AN ANNUAL REPORT TO THE MEMBERSHIP OF THE ASSOCIATION’S ACTIVITIES AND RECOMMENDATIONS OF THE BOARD OF DIRECTORS AT THE ANNUAL GENERAL MEETING. (E) PROVIDE NOTICE OF MEETINGS TO THE MEMBERS AND CONDUCT SUCH OTHER CORRESPONDENCE AS MAY BE REQUESTED BY THE PRESIDENT OR THE BOARD OF DIRECTORS. (F) SEND INVITATIONS AND MEETING INFORMATION TO GUESTS INVITED TO ATTEND THE ANNUAL MEETING AT THE REQUEST OF MEMBERS. (G) PAY ALL BILLS OF THE ASSOCIATION AND KEEP AN ITEMIZED ACCOUNT OF RECEIPTS AND EXPENDITURES. (H) BILL AND COLLECT ALL INITIATION FEES, DUES, ASSESSMENTS AND FUNDS AND DEPOSIT THEM IN SUCH BANK OR BANKS AS MAY BE DESIGNATED OR APPROVED BY THE BOARD OF DIRECTORS. (I) KEEP A RECORD OF ALL DUES-PAYING MEMBERS AND NOTIFY THE BOARD OF DIRECTORS OF THOSE DELINQUENT IN PAYMENT OF DUES (ARTICLE 10, SECTION 1.1). (J) BE CUSTODIAN OF ALL SALABLE PROPERTIES OF THE ASSOCIATION, SUBMIT AN INVENTORY OF THOSE PROPERTIES TO THE BOARD OF DIRECTORS ANNUALLY, AND COMPLETE ALL FORMS REQUIRED BY THE INTERNAL REVENUE SERVICE ON AN ANNUAL BASIS ACCORDING TO ITS DEADLINES. (K) PRESENT AN ANNUAL FINANCIAL REPORT TO THE MEMBERSHIP AT EACH ANNUAL GENERAL MEETING. (L) SERVE AS AN EX-OFFICIO MEMBER OF THE EAST FOUNDATION AND RECEIVE A REPORT OF ITS FUNCTIONS, DIRECTION, AND PROPERTIES. (M) OVERSEE THE ACTIVITIES OF THE CENTRAL OFFICE.
SECTION 7. THE RECORDER.
SECTION 7.1. THE RECORDER SHALL: (A) BE CHAIRPERSON OF THE PROGRAM COMMITTEE, WHICH WILL PREPARE THE PROGRAM FOR THE ANNUAL GENERAL MEETING. (B) PRESENT AN ANNUAL REPORT TO THE MEMBERSHIP. (C) BE RESPONSIBLE FOR THE CONDUCT OF THE ANNUAL MEETING INCLUDING AUDIO- VISUAL ARRANGEMENTS AND INSTRUCTIONS TO SPEAKERS AND DISCUSSANTS.
ARTICLE 3. BOARD OF DIRECTORS
SECTION 1. THE BOARD OF DIRECTORS SHALL BE COMPOSED OF THE PRESIDENT, PRESIDENT- ELECT, SECRETARY-TREASURER, RECORDER, IMMEDIATE PAST PRESIDENT, AND NO LESS THAN NINE (9) OR MORE THAN ELEVEN (11) ADDITIONAL, INDIVIDUAL DIRECTORS, THE NUMBER TO BE DETERMINED BY THE BOARD. ONE (1) OF THE NINE (9) TO ELEVEN (11) ADDITIONAL INDIVIDUAL DIRECTORS SHALL BE AN EX-OFFICIO MEMBER FROM THE SENIOR CATEGORY, WHO IS APPOINTED BY THE PRESIDENT. ALL OTHER BOARD MEMBERS SHALL BE ELECTED BY THE MEMBERSHIP.
SECTION 2. EACH PAST PRESIDENT SHALL SERVE A ONE (1) YEAR TERM ON THE BOARD OF DIRECTORS IMMEDIATELY AFTER COMPLETING A TERM AS PRESIDENT.
SECTION 3. DIRECTORS-AT-LARGE.
SECTION 3.1. THE DIRECTORS-AT-LARGE EACH SHALL SERVE A THREE (3) YEAR TERM COMMENCING AT THE CLOSE OF THE ANNUAL MEETING AT WHICH THEY ARE ELECTED AND TERMINATING AT THE CLOSE OF THE THIRD SUCCEEDING ANNUAL MEETING. DIRECTORS-AT-LARGE SHALL BE INELIGIBLE FOR RE-ELECTION.
SECTION 3.2. IF THE TERM OF A DIRECTOR-AT-LARGE WILL EXPIRE AT THE CLOSE OF THE ANNUAL MEETING, THE NOMINATING COMMITTEE SHALL NOMINATE ONE MEMBER FOR SUCH DIRECTOR-AT- LARGE POSITION AT THE BUSINESS MEETING. ADDITIONAL NOMINATIONS MAY BE MADE FROM THE FLOOR. THE VOTING MEMBERS PRESENT AT THE ANNUAL GENERAL MEETING SHALL ELECT EACH DIRECTOR-AT-LARGE FROM AMONG THE NOMINEES BY MAJORITY VOTE.
SECTION 4. IN THE EVENT OF THE DEATH, RESIGNATION, OR INCAPACITATION OF A DIRECTOR-AT- LARGE OR VACANCY OF A POSITION AS DIRECTOR-AT-LARGE, THE BOARD MAY, AT ITS OPTION, RECONVENE THE MOST RECENT NOMINATING COMMITTEE TO PROPOSE A NOMINEE FOR THE VACANT POSITION. THE BOARD WILL ELECT AN ELIGIBLE MEMBER OF THE ASSOCIATION TO SERVE THE REMAINDER OF THE TERM OR LEAVE THE POSITION VACANT.
SECTION 5. IN THE EVENT OF THE DEATH, RESIGNATION, OR INCAPACITATION OF ANY PAST PRESIDENT, THE NOMINATING COMMITTEE WILL NOMINATE ANY PREVIOUS PAST PRESIDENT TO COMPLETE THE TERM. THE BOARD OF DIRECTORS MAY CONFIRM THE NOMINEE BY A MAJORITY VOTE.
SECTION 6. THE BOARD OF DIRECTORS: (A) SHALL MANAGE THE AFFAIRS OF THE ASSOCIATION AND DETERMINE ITS POLICIES. (B) MAY INVITE ANY MEMBER OF THE ASSOCIATION TO PARTICIPATE IN ITS DELIBERATIONS AT ANY MEETING. (B) SHALL RECEIVE AND APPROVE THE REPORTS OF ALL COMMITTEES PRIOR TO PRESENTATION TO THE MEMBERSHIP AT THE ANNUAL MEETING. (D) WILL REVIEW AND APPROVE THE ACTIVITIES OF ALL COMMITTEES AS DEEMED NECESSARY BY THE BOARD. (E) SHALL ACCEPT, REJECT, OR DEFER APPLICATIONS FOR MEMBERSHIP IN THE ASSOCIATION.
SECTION 7. ANY DIRECTOR MAY CALL A MEETING OF THE BOARD OF DIRECTORS BY GIVING THIRTY (30) DAYS WRITTEN NOTICE THEREOF, WHICH REQUIREMENT MAY BE WAIVED BY THE UNANIMOUS CONSENT OF THE BOARD OF DIRECTORS. A MAJORITY OF THE BOARD OF DIRECTORS SHALL CONSTITUTE A QUORUM. THE AGENDA OF A SPECIAL CALL MEETING SHALL BE RESTRICTED TO THE SUBJECT STATED IN THE WRITTEN NOTICE.
ARTICLE 4. COMMITTEES
SECTION 1. STANDING COMMITTEES.
SECTION 1.1. THERE SHALL BE TEN (10) STANDING COMMITTEES IN THE ASSOCIATION: PROGRAM, MEMBERSHIP, NOMINATING, PUBLICATIONS, BYLAWS, SENIORS, CAREERS IN TRAUMA, INFORMATION MANAGEMENT-TECHNOLOGY, INJURY CONTROL-VIOLENCE PREVENTION, AND SCHOLARSHIP.
SECTION 1.2. THE CHAIRPERSON OF EACH STANDING COMMITTEE SHALL SERVE AS A VOTING MEMBER OF THE BOARD OF DIRECTORS. IN THIS CAPACITY, THE CHAIRPERSON WILL PROVIDE REGULAR UPDATES REGARDING COMMITTEE ACTIVITY DURING BOARD MEETINGS AND ANNUALLY TO THE MEMBERSHIP.
SECTION 1.3. MEMBERS OF STANDING COMMITTEES SERVE THREE YEAR TERMS AND ARE APPOINTED BY THE PRESIDENT, UNLESS OTHERWISE SPECIFIED.
SECTION 2. PROGRAM COMMITTEE.
SECTION 2.1. THE PROGRAM COMMITTEE SHALL BE RESPONSIBLE FOR THE FORMAT AND CONTENT OF THE ANNUAL SCIENTIFIC PROGRAM.
SECTION 2.2. THE PROGRAM COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 2.3. THE RECORDER SHALL SERVE AS CHAIRPERSON. MEMBERS OF THE PROGRAM COMMITTEE WILL BE APPOINTED BY THE PRESIDENT TO SERVE THREE (3) YEAR TERMS.
SECTION 2.4. THE NUMBER OF COMMITTEE MEMBERS, EXCLUDING THE CHAIRPERSON, SHALL NUMBER TWELVE (12).
SECTION 2.5. AT LEAST ONE SENIOR MEMBER WILL SERVE ON THE PROGRAM COMMITTEE.
SECTION 2.6. THE CHAIRPERSON OF THE PUBLICATIONS COMMITTEE AND THE CHAIRPERSON OF THE CAREERS IN TRAUMA COMMITTEE WILL BOTH SERVE AS EX-OFFICIO MEMBERS OF THE PROGRAM COMMITTEE.
SECTION 3. MEMBERSHIP COMMITTEE.
SECTION 3.1. THE CHAIRPERSON OF THE MEMBERSHIP COMMITTEE SHALL: (A) RECEIVE, VIA THE CENTRAL OFFICE, APPLICATIONS OF ALL CANDIDATES FOR MEMBERSHIP, OBTAIN AND RECORD LETTERS OF RECOMMENDATION FOR SUCH APPLICANTS FOR MEMBERSHIP AND SUBMIT THEM TO THE MEMBERSHIP COMMITTEE AND THE BOARD OF DIRECTORS (ARTICLE 1, SECTION 3.4). (B) DISTRIBUTE A LIST OF ALL CANDIDATES TO THE MEMBERSHIP BEFORE THE ANNUAL MEETING. (C) NOTIFY ALL CANDIDATES OF THEIR ELECTION TO MEMBERSHIP AND DISTRIBUTE CERTIFICATES OF MEMBERSHIP AND A COPY OF THE ASSOCIATION’S BYLAWS TO ALL NEW MEMBERS.
SECTION 3.2. THE MEMBERSHIP COMMITTEE SHALL CONSIDER ALL COMPLETED APPLICATIONS FOR MEMBERSHIP AND RECOMMEND CANDIDATES FOR ACTIVE, SENIOR, PROVISIONAL, STUDENT, ASSOCIATE, AND INTERNATIONAL-CORRESPONDING MEMBERSHIP TO THE BOARD OF DIRECTORS. THE MEMBERSHIP COMMITTEE SHALL RECORD THE LENGTH OF TERM OF MEMBERSHIP FOR ALL STUDENT AND PROVISIONAL MEMBERS. ANY STUDENT OR PROVISIONAL MEMBER WITH A TERM OF MEMBERSHIP LONGER THAN THAT PROVIDED BY THE BYLAWS SHALL BE SUBMITTED TO THE CENTRAL OFFICE FOR CONTACT AND POSSIBLE EXTENSION BY THE BOARD OF DIRECTORS.
SECTION 3.3. THE MEMBERSHIP COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE APPOINTED BY THE PRESIDENT AS CHAIRPERSON, A SECOND DIRECTOR-AT-LARGE, THE SECRETARY- TREASURER, THE PRESIDENT-ELECT, AND NO FEWER THAN FIVE (5) ACTIVE MEMBERS.
SECTION 3.4. THE MEMBERSHIP COMMITTEE SHALL PUBLISH A LIST OF ALL CANDIDATES WITH COMPLETED APPLICATIONS SHOWING MEMBER CLASS, ADDRESS, GRADUATE TRAINING, BOARD CERTIFICATION, SPONSORS, AND OTHER PERTINENT DATA. THE LIST SHALL BE SENT TO THE SECRETARY-TREASURER FOR DISTRIBUTION TO THE MEMBERSHIP BEFORE THE ANNUAL MEETING.
SECTION 3.5. THE MEMBERSHIP COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 4. NOMINATING COMMITTEE.
SECTION 4.1. AT THE ANNUAL GENERAL MEETING, THE NOMINATING COMMITTEE SHALL MAKE NOMINATIONS FOR PRESIDENT-ELECT, OR VACANCIES IN THE OFFICES OF SECRETARY-TREASURER, RECORDER, DIRECTORS-AT-LARGE, AND THE TWO (2) AT-LARGE MEMBERS OF THE NOMINATING COMMITTEE. THE NOMINATING COMMITTEE SHALL MAKE NOMINATIONS FOR MEMBERSHIP TO THE EAST FOUNDATION BOARD OF TRUSTEES (ARTICLE 11, SECTION 2-3).
SECTION 4.2. THE NOMINATING COMMITTEE SHALL CONSIST OF THE IMMEDIATE PAST PRESIDENT, THE PRESIDENT, THE PRESIDENT-ELECT, AND TWO (2) ACTIVE MEMBERS ELECTED BY THE MEMBERSHIP AT THE ANNUAL GENERAL MEETING. THE PAST PRESIDENT SHALL SERVE AS CHAIRPERSON.
SECTION 5. PUBLICATIONS COMMITTEE.
SECTION 5.1. THE PUBLICATIONS COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE APPOINTED BY THE PRESIDENT AS CHAIRPERSON AND NO LESS THAN FIVE (5) ACTIVE MEMBERS. MEMBERS WILL BE APPOINTED TO THREE (3) YEAR TERMS, AND THE COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 5.2. THE CHAIRPERSON OF THE PUBLICATIONS COMMITTEE SHALL RECEIVE ALL SCIENTIFIC PAPERS PRESENTED TO THE ASSOCIATION.
SECTION 5.3. THE PUBLICATIONS COMMITTEE SHALL BE RESPONSIBLE FOR: (A) APPROVING FORM AND CONTENT OF MANUSCRIPTS SUBMITTED. (B) SELECTING THOSE MANUSCRIPTS PRESENTED AT THE ANNUAL MEETING TO BE SUBMITTED TO THE EDITOR OF THE OFFICIAL JOURNAL FOR PUBLICATION. (C) MONITORING THE RELATIONSHIP WITH THE OFFICIAL JOURNAL OF THE ASSOCIATION. (D) OTHER SUCH MATTERS AS ARE RELATED TO PUBLICATION OF THE TRANSACTIONS OF THE ASSOCIATION.
SECTION 6. BYLAWS COMMITTEE.
SECTION 6.1. THE BYLAWS COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE AS CHAIRPERSON AND NO FEWER THAN THREE (3) ACTIVE MEMBERS. THE CHAIRPERSON AND ALL COMMITTEE MEMBERS SHALL BE APPOINTED BY THE PRESIDENT.
SECTION 6.2. THE BYLAWS COMMITTEE SHALL BE RESPONSIBLE FOR: (A) RECEIVING RECOMMENDATIONS FROM THE MEMBERSHIP PURSUANT TO PROPOSED CHANGES IN THE BYLAWS. (B) PRESENTING RECOMMENDATIONS FOR CHANGES OF THE BYLAWS TO THE MEMBERSHIP AT THE ANNUAL MEETING. (C) ENSURING THAT THE BYLAWS OF THE CORPORATION ARE IN ACCORDANCE WITH ALL PERTINENT FEDERAL AND STATE RULES AND REGULATIONS.
SECTION 6.3. THE BYLAWS COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 7. SENIORS COMMITTEE.
SECTION 7.1. THE SENIORS COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE AS CHAIRPERSON AND NO FEWER THAN EIGHT (8) MEMBERS MADE UP OF FORMER ACTIVE MEMBERS WHO HAVE BECOME SENIOR MEMBERS. THE PRESIDENT SHALL APPOINT THE CHAIRPERSON AND ALL COMMITTEE MEMBERS.
SECTION 7.2. THE SENIORS COMMITTEE SHALL BE RESPONSIBLE FOR ADVISING THE BOARD ON MATTERS THAT AFFECT THE ASSOCIATION AT THE INVITATION OF THE BOARD.
SECTION 7.3. THE SENIORS COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 8. CAREERS IN TRAUMA COMMITTEE.
SECTION 8.1. THE CAREERS IN TRAUMA COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE AS CHAIRPERSON AND NO FEWER THAN FIVE (5) ACTIVE OR SENIOR MEMBERS. THE CHAIRPERSON AND ALL COMMITTEE MEMBERS SHALL BE APPOINTED BY THE PRESIDENT.
SECTION 8.2. THE CAREERS IN TRAUMA COMMITTEE SHALL BE RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD AND TO THE ASSOCIATION MEMBERSHIP REGARDING MEANS BY WHICH EAST MAY ASSIST AND STIMULATE YOUNG INDIVIDUALS INTO ACTIVELY PURSUING CAREERS IN TRAUMA CARE.
SECTION 8.3. THE CAREERS IN TRAUMA COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 9. INFORMATION MANAGEMENT AND TECHNOLOGY COMMITTEE.
SECTION 9.1. THE INFORMATION MANAGEMENT AND TECHNOLOGY COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE AS CHAIRPERSON AND NO FEWER THAN (5) ACTIVE OR SENIOR MEMBERS. THE CHAIRPERSON AND ALL COMMITTEE MEMBERS SHALL BE APPOINTED BY THE PRESIDENT.
SECTION 9.2. THE INFORMATION MANAGEMENT AND TECHNOLOGY COMMITTEE SHALL BE RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD AND TO THE ASSOCIATION MEMBERSHIP ON MEANS OF DISSEMINATING KNOWLEDGE AND EDUCATION IN THE SCIENCE OF TRAUMA.
SECTION 9.3. THE INFORMATION MANAGEMENT AND TECHNOLOGY COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 10. INJURY CONTROL AND VIOLENCE PREVENTION COMMITTEE.
SECTION 10.1. THE INJURY CONTROL AND VIOLENCE PREVENTION COMMITTEE SHALL CONSIST OF A DIRECTOR-AT-LARGE AS CHAIRPERSON AND NO FEWER THAN EIGHT (8) ACTIVE OR SENIOR MEMBERS. THE CHAIRPERSON AND ALL COMMITTEE MEMBERS SHALL BE APPOINTED BY THE PRESIDENT.
SECTION 10.2. THE INJURY CONTROL AND VIOLENCE PREVENTION COMMITTEE WILL BE A RESOURCE TO THE MEMBERSHIP ON INJURY DATA AND INTERVENTIONAL STRATEGIES FOR RESEARCH AND EDUCATION IN THE ADVANCEMENT OF THE OVERALL MISSION OF EAST.
SECTION 10.3. THE INJURY CONTROL AND VIOLENCE PREVENTION COMMITTEE SHALL BE RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD AND THE ASSOCIATION MEMBERS REGARDING MEANS OF INFORMATION COLLECTION, DISSEMINATION, INJURY PREVENTION METHODOLOGY, AND RESEARCH AS WELL AS ALL COLLABORATIONS WITH OTHER ORGANIZATIONS OR PARTNERS.
SECTION 10.4. THE INJURY CONTROL AND VIOLENCE PREVENTION COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 11. SCHOLARSHIP COMMITTEE.
SECTION 11.1. THE SCHOLARSHIP COMMITTEE SHALL CONSIST OF A DIRECTOR AT LARGE AS CHAIRPERSON AND NO FEWER THAN SIX (6) ACTIVE OR SENIOR MEMBERS.
SECTION 11.2. THE SCHOLARSHIP COMMITTEE SHALL DETERMINE THE RECIPIENT OF ALL SCHOLARSHIP AND GRANTS AWARDED BY EAST.
SECTION 11.3. THE SCHOLARSHIP COMMITTEE SHALL BE SO STRUCTURED AS TO PROVIDE FOR AN ANNUAL TURNOVER OF NOT LESS THAN ONE-THIRD (1/3) OF ITS MEMBERS, EXCLUDING THE CHAIRPERSON.
SECTION 12. AD HOC COMMITTEES.
SECTION 12.1. AD HOC COMMITTEES ARE CREATED BY THE PRESIDENT WITH THE APPROVAL OF THE BOARD OF DIRECTORS TO ADDRESS SPECIFIC ISSUES OR COMPLETE SPECIFIC TASKS RELATED TO THE STATED GOALS OF THE ASSOCIATION.
SECTION 12.2. AD HOC COMMITTEES ARE NOT BOUND BY A SPECIFIC TERM. THEY ARE ASSEMBLED AND DISSOLVED, AS REQUIRED, BY THE PRESIDENT.
SECTION 12.3. THE LEADERSHIP AND COMPOSITION OF EACH AD HOC COMMITTEE WILL BE DETERMINED BY THE PRESIDENT.
SECTION 12.4. THE CHAIRPERSON OF EACH AD HOC COMMITTEE SHALL SERVE A ONE YEAR TERM SUBJECT TO RENEWAL BY THE PRESIDENT FOR UP TO THREE YEARS. IN THIS CAPACITY, THE CHAIRPERSON WILL PROVIDE REGULAR UPDATES REGARDING COMMITTEE ACTIVITY DURING BOARD MEETINGS AND ANNUALLY TO THE MEMBERSHIP.
ARTICLE 5. ANNUAL MEETING
SECTION 1. AN ANNUAL MEETING OF THE ASSOCIATION SHALL BE HELD AT A TIME AND PLACE DESIGNATED BY THE BOARD OF DIRECTORS. THE ANNUAL MEETING SHALL CONSIST OF A SCIENTIFIC PROGRAM, A GENERAL MEETING, AND A SOCIAL PROGRAM.
SECTION 2. ALL REGULAR ELECTIONS SHALL OCCUR AT THE ANNUAL GENERAL MEETING.
SECTION 3. PAPERS AND PUBLICATIONS.
SECTION 3.1. MEMBERS AND GUESTS OFFERING PAPERS FOR PRESENTATION AT THE ANNUAL MEETING SHALL FURNISH THE RECORDER WITH TITLES, ABSTRACTS, OR OTHER MATERIAL IN A FORMAT AND A TIME DESIGNATED BY THE RECORDER.
SECTION 3.2. GUESTS OFFERING PAPERS MUST HAVE THE PAPER SPONSORED BY A MEMBER OF THE ASSOCIATION.
SECTION 4. TEN PERCENT (10%) OF THOSE ELIGIBLE TO VOTE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT THE ANNUAL GENERAL MEETING OR A SPECIAL MEETING.
SECTION 5. ALL MEETINGS OF THE ASSOCIATION SHALL BE CONDUCTED ACCORDING TO THESE BYLAWS AND THE MOST CURRENT REVISION OF PARLIAMENTARY PROCEDURES ACCORDING TO ROBERT’S RULES OF ORDER.
ARTICLE 6. DUES AND FEES
SECTION 1. THE BOARD OF DIRECTORS SHALL DETERMINE THE APPLICATION FEE FOR NEW MEMBERS.
SECTION 2. ACTIVE, SENIOR, PROVISIONAL, STUDENT, AND ASSOCIATE MEMBERS MUST PAY DUES. ANY MEMBER NOT PAYING DUES, FEES, OR OTHER ASSESSMENTS TO THE ORGANIZATION WHEN DUE WILL BE CONSIDERED NOT IN GOOD STANDING WITH THE ORGANIZATION. ANNUAL DUES AND METHOD OF PAYMENT SHALL BE DETERMINED BY THE BOARD OF DIRECTORS. HONORARY, EMERITUS, INTERNATIONAL-CORRESPONDING, FOUNDING, AND THE ORIGINAL BOARD MEMBERS ARE EXEMPTED FROM PAYING DUES.
SECTION 3. THE SECRETARY-TREASURER SHALL NOTIFY ALL MEMBERS IN ARREARS OF DUES.
SECTION 4. GUEST FEES AND REGISTRATION FEES FOR THE ANNUAL MEETING SHALL BE DETERMINED BY THE BOARD OF DIRECTORS.
SECTION 5. SPECIAL ASSESSMENTS MAY BE RECOMMENDED BY THE BOARD OF DIRECTORS AND SHALL BE LEVIED ON THE MEMBERS OF THE ASSOCIATION IF APPROVED BY A TWO-THIRDS (2/3) AFFIRMATIVE VOTE OF THE VOTING MEMBERS IN ATTENDANCE AT A GENERAL OR SPECIAL MEETING.
ARTICLE 7. RESIGNATIONS
SECTION 1. ANY MEMBER MAY WITHDRAW FROM THE ASSOCIATION AFTER FULFILLING ALL OBLIGATIONS AND THEN GIVING WRITTEN NOTICE OF SUCH INTENTION TO THE SECRETARY- TREASURER. THIS NOTICE SHALL BE PRESENTED TO THE BOARD OF DIRECTORS AT THE FIRST MEETING FOLLOWING ITS RECEIPT. RESIGNATION BECOMES EFFECTIVE UPON APPROVAL BY THE BOARD OF DIRECTORS.
ARTICLE 8. AMENDMENTS
SECTION 1. THE BYLAWS OF THE ORGANIZATION CAN ONLY BE AMENDED BY THE MEMBERSHIP AT THE ANNUAL GENERAL MEETING OF THE ASSOCIATION. THE SUGGESTED AMENDMENT MUST HAVE BEEN PRESENTED IN WRITING TO THE BYLAWS CHAIRPERSON AND APPROVED BY THE BOARD OF DIRECTORS. ALL VOTING MEMBERS SHALL BE NOTIFIED ABOUT THE PROPOSED AMENDMENT TO THE BYLAWS AT LEAST FORTY-FIVE (45) DAYS PRIOR TO THE ANNUAL MEETING BY E-MAIL, WEB POSTING, MAIL, AND/OR FACSIMILE. THE AMENDMENT MUST BE APPROVED BY THE LESSER OF: (i) TWO THIRDS (2/3) OF VOTES CAST AT A MEETING OF THE MEMBERS AT WHICH A QUORUM IS PRESENT OR (ii) A MAJORITY OF THE VOTING MEMBERS.
ARTICLE 9. CERTIFICATE OF MEMBERSHIP
SECTION 1. A CERTIFICATE OF MEMBERSHIP WILL BE DESIGNED AND ISSUED TO EACH MEMBER, SIGNED BY THE PRESIDENT AND THE SECRETARY-TREASURER, AND SHALL REMAIN THE PROPERTY OF THE ASSOCIATION.
ARTICLE 10. LOSS OF MEMBERSHIP
SECTION 1. A MEMBER MAY BE DROPPED FROM MEMBERSHIP UNDER THE FOLLOWING CIRCUMSTANCES: (A) FAILURE TO ADHERE TO THE OBLIGATIONS AND OBJECTIVES OF THE ASSOCIATION SET FORTH IN THE ARTICLES OF INCORPORATION AND THE BYLAWS. (B) FAILURE TO REMIT DUES FOR MORE THAN TWO (2) CALENDAR YEARS. (C) FAILURE FOR ANY REASON TO MAINTAIN GOOD STANDING IN THE MEDICAL PROFESSION.
SECTION 1.1. ANY ACTIVE, SENIOR, PROVISIONAL, OR ASSOCIATE MEMBER WHOSE DUES ARE IN ARREARS FOR TWO (2) YEARS SHALL BE NOTIFIED THROUGH REGISTERED LETTER BY THE SECRETARY-TREASURER. IF PAYMENT IS NOT RECEIVED WITHIN TWO (2) MONTHS THEREAFTER, MEMBERSHIP SHALL BE FORFEIT.
SECTION 1.2. THE BOARD OF DIRECTORS MUST ACT UNANIMOUSLY TO IMPLEMENT THIS ARTICLE AND WILL ACCORDINGLY NOTIFY THE MEMBER CONCERNED BY REGISTERED LETTER.
SECTION 1.3. APPEAL OF ACTIONS OF THE BOARD OF DIRECTORS MUST BE SUBMITTED TO THE SECRETARY-TREASURER IN WRITING FOR PRESENTATION TO THE BOARD OF DIRECTORS. A DECISION ON THE APPEAL MUST BE RENDERED TO THE APPELLANT IN WRITING BY CERTIFIED LETTER WITHIN THIRTY (30) DAYS AFTER THE MEETING OF THE BOARD OF DIRECTORS AT WHICH THE APPEAL IS PRESENTED.
ARTICLE 11. EAST FOUNDATION
SECTION 1. THE EAST FOUNDATION SHALL BE ESTABLISHED AS A NON-PROFIT ORGANIZATION DEDICATED TO THE CHARITABLE SUPPORT AND DEVELOPMENT OF PROGRAMS TO ASSURE FUTURE CARE OF TRAUMA PATIENTS, INVESTIGATION INTO CLINICAL AND BASIC SCIENCE PERTAINING TO THE CARE OF INJURED PATIENTS, OUTCOMES RESEARCH, PUBLIC AWARENESS OF INJURY AND ITS CARE, AND PREVENTION OF INJURY.
SECTION 2. THE FOUNDATION WILL MANAGE EXISTING FUNDS ALREADY GATHERED FOR THESE PURPOSES. ADDITIONAL FUNDS ARE TO BE RAISED FROM DONATIONS GATHERED FROM SOURCES WITHIN AND EXTERNAL TO CURRENT TRAUMA CARE PROVIDERS.
SECTION 3. THE EAST FOUNDATION SHALL BE GOVERNED BY A BOARD OF TRUSTEES. THE MEMBERS OF THIS BOARD SHALL BE SELECTED BY PROCEDURES AS OUTLINED IN THE EAST BYLAWS. THE PRESIDENT AND SECRETARY-TREASURER OF EAST SHALL SERVE ON THE EAST FOUNDATION BOARD AS EX-OFFICIO MEMBERS. THE IMMEDIATE PAST PRESIDENT OF EAST SHALL SERVE AS A MEMBER OF THE EAST FOUNDATION FOR A TERM OF THREE YEARS.
ARTICLE 12. INTERPRETATION
SECTION 1. IN THE EVENT OF DISPUTE, THE PROVISIONS OF THESE BYLAWS WILL BE INTERPRETED ACCORDING TO THE LAWS OF THE STATE OF TENNESSEE.
membership roster s of december 1, 2012 A *
EAST Membership - Geographical
International Israel Miklosh Bala, MD Australia Yoram S. Kluger, MD Damian McMahon, MD Avraham I. Rivkind, MD Brazil Italy Ricardo A. Abdalla, Massimo Chiarugi, MD Joao B. Rezende-Neto, MD, PhD, FACS Pakistan Canada Amyn Pardhan, MBBS, MRCS, FCPS Eric Bergeron, MD, MSC Talat Chughtai, MD Qatar Paul Engels, Yasir Al Zubaidi, MD Kosar A. Khwaja, MD, MBA, MSc, FACS Rifat Latifi, MD Damian Maxwell, MBBS Ahmad M Zarour, MD Avery B. Nathens, MD, PhD, MPH Thamer Nouh, MD, FRCSC South Africa Neil G. Parry, MD Kenneth D. Boffard, MD Tarek S. Razek, MD, FACS United Arab Emirates Sandro Rizoli, MD, PhD, FRCSC, FACS Ruben Peralta, MD Homer Tien, MD Lorraine N. Tremblay, MD, PhD, FACS, United Kingdom FRCSC Adam J. Brooks, Vincent Trottier, MD, FRCSC, FACS Susan I. Brundage, MD, MPH, FACS Mazin Tuma, MD Steven J. Hughes, MD Mary H. vanWijngaarden, MD Morgan P. McMonagle, MB, BCh, BAO, MD, FRCSI Finland Ari K. Leppaniemi, MD, PhD United States Germany AE Michael L. Nerlich, MD Joel B. Elterman, MD Ulf Schmidt, MD Gerald Richard Fortuna, Jr., MD Dirk Stengel, MD, PhD, MSc Mark S. Johnson, MD Kathleen D. Martin, RN, MSN Shawn C. Nessen, DO, FACS David Zonies, MD EAST Membership - Geographical
Alabama Forrest O. Moore, MD, FACS Patrick L Bosarge, MD Terence O'Keeffe, MD, MSPH Sidney Brevard, MD, MPH Patrick J. O'Neill, PhD, MD Mohammad Frotan, MD Kumash Patel, MD, FACS Richard P. Gonzalez, MD Paola Pieri, MD Jeffrey D. Kerby, MD, PhD Peter Rhee, MD, MPH Arnold Luterman, MD Jeffrey P. Salomone, MD, FACS, Kristopher Maday, MS, PA-C NREMT-P Kimball I. Maull, MD Andrew L. Tang, MD Sherry M. Melton, MD Gary A. Vercruysse, MD Richard L. Mullins Jr., MD Mark D. Williams, MD Rony Jamil Najjar, MD Julie L. Wynne, MD, MPH Randall W. Powell, MD Michelle L. Ziemba, MSN Donald A. Reiff, MD Loring W. Rue III, MD Arkansas Jon D. Simmons, MD John B. Cone, MD G. Girish Chandra Varma, MD Joseph C. Jensen, MD, MHA, FACS John M. Vermillion, MD Robert Todd Maxson, MD, FACS Richard G. Winters, D.H.Sc., PA-C Michael J. Sutherland, MD Arizona California Vicki Bennett, RN, MSN Brian Acker, MD Richard H. Carmona, MD, MPH, FACS W. Christopher Bandy, MD, FACS G. Paul Dabrowski, MD Cristobal Barrios, MD Ara Feinstein, MD, MPH John Bilello, MD Randall S. Friese, MD Rachael Callcut, MD, MSPH Vafa Ghaemmaghami, MD Richard D. Catalano, MD James J. Gonzales, MD Hillary Chollet, MD Charles Kung Chao Hu, MD, MBA, FACS, Ray Siukueng Chung, MD FCCP Henry (Gill) M. Cryer III, MD, PhD David C. Johnson, MD Ajit Deol, MD Steven B. Johnson, MD Thomas K. Duncan, DO, FACS Bellal Joseph, MD William Dutton, MD Tammy R. Kopelman, MD, FACS Henri R. Ford, MD Narong Kulvatunyou, MD Heidi Frankel, MD, FACS, FCCM Terrence J. Loftus, MD Daniel J. Grabo, MD Marc R. Matthews, MD Peter M Hammer, MD EAST Membership - Geographical
Matthew Hannon, MD Colorado Odette Althea Harris, MD, MPH Walter L. Biffl, MD Rachel Hight, MD Julie A. Dunn, MS, MD Elsa R. Hirvela, MD Gregory J. Jurkovich, MD Robert A. Izenberg, MD Steven Y. Kim, MD Stephen Kaminski, MD Gary E. Lane, MD, FACS Joseph A. Karam, MD Brian E. Leininger, MD, FACS Krista L. Kaups, MD, FACS Ernest E. Moore, MD Terrence H. Liu, MD Roger J. Nagy, MD, FACS Ahmed Mahmoud, MD Donna A. Nayduch, RN, MSN, ACNP, Amal Obaid, MD CAISS Nancy A. Parks, MD William F. Pfeifer III, MD Kimberly A. Peck, MD Paul E. Reckard, MD, MBA Jon Perlstein, MD, FACS Joel Schaefer, MD Pavel Petrik, MD Michael J. Schurr, MD David S. Plurad, MD Bruce M. Potenza, MD Connecticut Javier A Romero, MD Michael S. Ajemian, MD Bradley Roth, MD Farzad Amiri, MD Shawki Saad, MD Nabil A. Atweh, MD Edgardo S. Salcedo, MD James E. Barone, MD, FACS, FCCM Ali Salim, MD Bishwajit Bhattacharya, MD Christojohn Samuel, MD Robert T. Brautigam, MD, FACS Humberto Sauri, MD, FACS Karyn L. Butler, MD, FACS, FCCM Brian F. Schmidt, MD Brendan T. Campbell, MD, MPH David V. Shatz, MD Matthew Carlson, MD Tchaka B. Shepherd, MD Carla A. Carusone, RN Michael Sise, MD Charles L. Castiglione, MD, FACS Ruby A. Skinner, MD Norman J. Cavanagh, MD Lawrence Sue, MD Walter Cholewczynski, MD Tony Y.M. Tam, MD David Coletti, MD Ricard N. Townsend, MD Kimberly A. Davis, MD, MBA, FACS, Jeffrey S. Upperman, MD FCCM Michael A. West, MD, PhD Karen Diefenbach, MD Philip R. Wolinsky, MD Michael Ditillo, DO David Tai-Wai Wong, MD Kevin M. Dwyer, MD, FACS John P. Zopfi, DO James M. Feeney, MD EAST Membership - Geographical
Dana Forlano, BS, MSN BC, CCRN, PhD(c) Joseph R. Gordon, MD, FACS Peter Zdankiewicz, MD Timothy S. Hall, MD, FACS Tobias H Zingg, MD Lenworth M. Jacobs, Jr., MD, MPH Dirk Johnson, MD Delaware D'Andrea K. Joseph, MD Edward L. Alexander III, MD Richard Judd, PhD Marilynn Bartley, MSN Gary J. Kaml, MD Kevin M. Bradley, MD, FACS Lewis J. Kaplan, MD, FACS, FCCM, FCCP Mark D. Cipolle, MD, PhD Rae Lynne P. Kinler, MD Gerard J. Fulda, MD, FACS, FCCM Orlando C. Kirton, MD Frederick A. Giberson, MD Vivian A. Lane, RN Judith A. Graybeal, BSN Kathleen A. LaVorgna, MD, FACS Michael Kalina, DO Jessica Lee, MD Joan M. Pirrung, RN, MSN, ACNS-BS Rebecca M. Lofthouse, BSN Michael Rhodes, MD, FACS Gina M. Luckianow, PA-C Nadiv Shapira, MD Felix Y. Lui, MD, FACS Georgianna Telford, BSN, MSN, CRNP, Evadne G. Marcolini, MD FNP-BC Adrian A Maung, MD Glen H. Tinkoff, MD Jeffrey J. Meter, MD Pamela Woods, RN, ACNS-BC, CEN Anthony S. Morgan, MD Distric of Columbia Gillian Mosier, MSN Chadi Abouassaly, MD Judith A. O'Connor, RN Randall S. Burd, MD Rocco Orlando III, MD Edward E. Cornwell III, MD Janis A. Pastena, MD, MPH, FACS, FACEP James R. Dunne, MD Greta L. Piper, MD Wendy Greene, MD Joseph V. Portereiko, DO, FACS Erin Hall, MD, MPH Paul P. Possenti, PA-C James C. Jeng, MD Carla P. Rennie, RN, MSN Laura S Johnson, MD Jeuse Saint-Fleur, APRN Marion H. Jordan, MD Alisa Savetamal, MD E. Gregory Marchand, MD John T. Schulz III, MD, PhD Babak Sarani, MD Kevin M. Schuster, MD Mark W. Sebastian, MD, FACS Florida Sheila M. Staib, RN John Adamski, II, MD, MSc, MPH Denis Tereb, MD Rodrigo F Alban, MD Giuseppina (Pina) Violano, MSPH, RN- EAST Membership - Geographical
Rona E. Altaras, MD Danny Jazarevic, MD, PhD Darwin Ang, MD Jeffrey L. Johnson, MD John H. Armstrong, MD, FACS Judith M. Johnson, MD Linda R. Atteberry, MD Andrew J. Kerwin, MD Ben L. Bachulis, Suneel Khetarpal, MD, FRCS-C Erik S. Barquist, MD, FACS Brian J. Kimbrell, MD Robert E. Benjamin, Jr., MD Jeffrey Koby, PA-C Indermeet Bhullar, MD Matthew S. Kozloff, MD Ernest FJ Block, MD, MBA, EMT-P Stanley J. Kurek Jr., DO, FACS J. Bracken Burns, Jr., MS, DO Seong K. Lee, MD Patricia M. Byers, MD, FACS Scott Lentz, MD Eddy H. Carrillo, MD, FACS Pamela Stokes Li, MSN, ARNP-BC Joseph D. Catino, MD Luis E. Llerena, MD Michael L. Cheatham, MD, FACS, FCCM Lawrence Lottenberg, MD David J. Ciesla, MD, MA Matthew W. Lube, MD Susan Cooke, PA-C, MCMS Mauricio Lynn, MD Joshua G Corsa, MD Kerry Maher, MD Paul D. Danielson, MD Mark G. McKenney, MD Anthony J. Del Rossi, MD David W. Mozingo, MD James W. Dennis, MD Nicholas Namias, MD Rodney M. Durham, MD Peter A. Pappas, MD FACS Philip Efron, MD Joseph W. Pearce, MD Ahmed Elhaddad, MD Louis R. Pizano, MD Steven G. Epstein, MD Donald A. Plumley, MD David Farcy, MD Levi Procter, MD Timothy C. Flynn, MD John T. Promes, MD Eric R. Frykberg, MD Ivan Puente, MD Alejandro Garcia, MD Jin Ra, MD George D. Garcia, MD Marcela Ramirez, MD Karanbir S. Gill, MD Hernan M. Reyes, MD Enrique Ginzburg, MD Edgar Rodas, MD Pedro J. Gonzalez, MD Andrew A. Rosenthal, MD Patrick Gonzalez Jr., MD, FACS Erin E. Ross, PA-C, MMSc Enrique R. Grisoni, MD Andrew C. Ruoff III, MD Robert B. Holtzman, MD Angeleke Saridakis, MD, MPH Joan L. Huffman, MD Miren A. Schinco, MD James M. Hurst, MD Carl I. Schulman, MD, MSPH EAST Membership - Geographical
Romualdo J. Segurola Jr., MD Vernon Henderson, MD David H. Shapiro, MD, FACS Debra E Houry, MD, MPH Chadwick P. Smith, MD A. Christopher Ibikunle, MD Howard G. Smith, MD Debra Kitchens, RN, CEN, NREMT-P Olu Sobowale, MD Heather G. Mac New, MD Richard Sontchi, MD Jana B.A. MacLeod, MD, MSc, FRCS(C), Glenn E. Summers, Jr., MD FRC(ECSA), FACS Joseph J. Tepas III, MD Romeo Massoud, MD Hugh S. Unger, MD Patrick McGann, MD Ernst E. Vieux, Jr., MD Regina Simione Medeiros, DNP, MHSA, David H. Villarreal, RN C. Bruce Walsh, MD Elizabeth G NeSmith, PhD, MSN, ACNP- Bill C. Welch, MD BC William Welch, MD Jeffrey M. Nicholas, MD, MS, FACS Thomas D. Wells, MD M. Gage Ochsner, Jr., MD, FACS Dietmar H. Wittmann, MD, PhD John W. Odom, MD Tanya L. Zakrison, MD, FRCSC Gregory L. Peck, DO Michele K. Ziglar, MSN, RN Ravi Rajani, MD Philip T. Ramsay, MD Georgia Barry M. Renz, MD Ryan Armstrong, MD Grace S. Rozycki, MD, FACS Dennis W. Ashley, MD Donald C. Siegel, MD Hany Y. Atallah, MD, FACEP Anuradha Subramanian, MD Avi Bhavaraju, MD Joseph M. Van De Water, MD Carl R. Boyd, MD Mark L. Walker, MD William J. Bromberg, MD Amy D. Wyrzykowski, MD Timothy G. Buchman, MD Alisa Cavitt, MD Hawaii Jamie J. Coleman, MD Raquel C. Bono, MD Omar K. Danner, MD Frank E. Davis III, MD Idaho Christopher J. Dente, MD Steven R. Casos, MD Kevin J. Farrell, MD Billy Morgan, MD David V. Feliciano, MD Brian O'Byrne, MD R. Scott Hannay, MD L. R. 'Tres' Scherer III, MD John Harvey, MD Michael L. Hawkins, MD EAST Membership - Geographical
Illinois Steven L. Salzman, DO Spyro Analitis, MD John M. Santaniello, MD John A. Barrett, MD Michael B. Shapiro, MD Faran Bokhari, MD, MBA, FACS, FACP Edward P. Sloan, MD, MPH, FACEP Will P. Chapleau, EMT-P, RN, TNS Frederic L. Starr, MD Robert A. Cherry, MD Mindy B. Statter, MD Katherine K. Christoffel, MD John P. Sutyak, MD, FACS James Peter Cole, Jr., DO, FACS Mamta Swaroop, MD Marie L. Crandall, MD, MPH Casey Thomas, DO Andrew J. Dennis, DO, FACOS Yalaunda M. Thomas, MD James C. Doherty, MD Thomas Vargish, MD Richard P. Dutton, MD, MBA Jarrod Wall, MB, BCh, BAO,PhD James B. Ebert, MD Dorion E. Wiley, MD Thomas J. Esposito, MD, MPH, FACS Christopher D. Wohltmann, MD Richard J. Fantus, MD Lewis M. Flint, MD Indiana Donald E. Fry, MD Thomas A. Broadie, MD, PhD Linda A. Galambos, ACNP Eric G. Cure, MD Richard L. Gamelli, MD Mark E. Falimirski, MD Jane Harper, PhD, RN, ACNP-BC, CCNS, Seferino Farias, MD, MS CNRN, CCRN Alison Fecher, MD Michele R. Holevar, MD John Francis, MD, FACS David B. Hoyt, MD, FACS Gerardo A. Gomez, MD Nabil Issa, MD Cary L. Hanni, MD, FACS Kimberly T. Joseph, MD Thomas Z. Hayward III, MD Jane Kayle Jaein Lee, MD Lewis E. Jacobson, MD, FACS Peter B. Letarte, MD Stephen Lanzarotti, MD Fred A. Luchette, MD, FACS, FCCM Gary W. Lemmon, MD J. Stephen Marshall, MD Bryan P. Mathieson, MSN David P. McElmeel, MD Larry T. Micon, MD, FACS Michael J. Mosier, MD William J. Millikan Jr., MD Kimberly K. Nagy, MD, FACS Timothy H. Pohlman, MD Uretz J. Oliphant, MD, FACS, FICS R. Lawrence Reed II, MD Laurel A. Omert, MD Donald N. Reed, Jr., MD Ellen C. Omi, MD Clark J. Simons, MD Edward C Pyun Jr., MD Katie Jo Stanton-Maxey, MD Roxanne R. Roberts, MD Byron Stephens, BS EAST Membership - Geographical
Erik W. Streib, MD Cynthia Talley, MD W. Matthew Vassy, MD Brian Tucker, DO Iowa Louisana Philip R. Caropreso, MD Juan C. Duchesne, MD, FACS, FCCP Kent C. Choi, MD Michael Fahr, MD Kenneth John Hartman, Jr., MD, FACS John P. Hunt III, MD, MPH Joel Shilyansky, MD Tomas H. Jacome, MD Richard A. Sidwell, MD, FACS Philip C. Lindsay, MD Dionne A. Skeete, MD Stephenie R. Long, MD James R. Swegle, MD, FACS Alan B. Marr, MD, FACS Norman E. McSwain, Jr., MD, FACS, Kansas NREMT-P Carla C. Braxton, MD, MBA, FACS Peter Meade, MD, MPH David A. Cancelada, MD Navdeep S. Samra, MBBS, MS, MD Maxime J.M. Coles, MD Cuthbert O. Simpkins II, MD Don R Fishman, MD, MBA Lance E Stuke, MD, MPH James M. Haan, MD Mary Whitlock, MD Michael Moncure, MD Mary Jo Wright, MD Robert Pruitt, MD, MBA Asser M. Youssef, MD, MBChB Kentucky Maine James F. Bardgett, MD John K. Baxter III, MD Matthew Benns, MD David L. Ciraulo, DO, MPH Andrew C. Bernard, MD David E. Clark, MD Bernard R. Boulanger, MD, FACS Brad M. Cushing, MD Noreen K. Durrani, MD Virginia A. Eddy, MD Mary E. Fallat, MD Mark Grant, MBBS Glen A. Franklin, MD Gene A. Grindlinger, MD Brian G. Harbrecht, MD Rafael J. Grossmann-Zamora, MD James Hwang, MD, MS Joan D. Pellegrini, MD Joseph A. Iocono, MD Anita D Praba-Egge, MD, PhD Paul A. Kearney, MD Ian G. Reight, MD Katie M. Love, MD Kristen C. Sihler, MD, MS Frank B. Miller, MD Sasha Sotirovic, MD Jason Smith, MD Joseph Taddeo, MD EAST Membership - Geographical
Maryland Ellen J. Mackenzie, PhD Donald Bennett, MD, MA, MS Debra L. Malone, MD Willie C. Blair, MD, FACS Nathaniel McQuay, Jr., MD Phillip E. Bovender, RN, BSN, CCRN Jay Menaker, MD John S. Brebbia, MD Philip R. Militello, MD Brian Brewer, MD David P. Milzman, MD Brandon Bruns, MD Roy A.M. Myers, MD Howard R. Champion, MD, FRCS (Edin) David V. Nasrallah, MD (Eng), FACS Scott H. Norwood, MD Albert Chi, MD Myung Park, MD William C. Chiu, MD, FACS, FCCM Bikram K. Paul, MD Michael Cooley, ACNP-BC Daniel Powers, MD Carnell Cooper, MD, FACS Laurie Punch, MD James G. Cushman, MD Joseph Rabin, MD Jose J. Diaz, MD Norman Rich, MD Karen E Doyle, MBA, MS, RN, NEA-BC Carlos J. Rodriguez, DO, MBA, FACS Joseph J. DuBose, MD Gabriel E. Ryb, MD, MPH, FACS David T. Efron, MD Thomas M. Scalea, MD, FACS, FCCM Raymond Fang, MD, FACS Diane Schwartz, MD Farshad Farnejad, MD MPH Stacy A. Shackelford, MD Marcie Feinman, MD Robert Sikorski, MD Samuel Galvagno, MD Alan A. Simeone, MD Thomas Genuit, MD, FACS Amy C. Sisley, MD, MPH Adil H. Haider, MD, MPH Carl A. Soderstrom, MD J. Alex Haller, MD Deborah M. Stein, MD Robbi L. Hartsock, RN, MSN, RNP Ronald B. Tesoriero, MD Erik A. Hasenboehler, MD Tracy Timmons, MD Elliott R. Haut, MD, FACS Catherine Velopulos, MD Sharon M. Henry, MD Cassandra Villegas, Obeid N. Ilahi, MD Sharon L. Weintraub, MD, MPH Jonathan H. Jaffin, MD Dany Westerband, MD, FACS Elliot M. Jessie, MD, MBA Susan M. Ziegfeld, CRNP Preeti John, MD, MPH Mark D. Kligman, MD Massachusetts Joseph J. Larivey, CRNP J. M. Kofi Abbensetts, MD Benjamin K. Laughton, MBS, MSN, CRNP Frederick W. Ackroyd, MD Matthew E. Lissauer, MD Salman Ahmad, MD EAST Membership - Geographical
Reginald Alouidor, MD Richard L. Paulson, MD Reza Askari, MD David A. Peak, MD Susan M. Briggs, MD Joseph L. Pfeifer III, MD, FACS Tricia L. Charise, NP Reuven Rabinovici, MD Walter J. Chwals, MD Ali S. Raja, MD, MBA, MPH Alasdair K.T. Conn, MD Michael S. Rosenblatt, MD, MBA, MPH Timothy C. Counihan, MD, FACS, Daniel P. Ryan, MD FASCRS Heena P. Santry, MD, MS, BA Tracey Dechert, MD Robert L. Sheridan, MD Marc A. deMoya, MD Bruce J. Simon, MD Andrew R Doben, MD Ronald G. Tompkins, MD Robert P. Driscoll, MD, FACS James F. Watkins, MD, MSc Timothy A. Emhoff, MD Eleanor S. Winston, MD Peter Fishman, MD Daniel Dante Yeh, MD Jonathan D. Gates, MD, MBA Andrew Glantz, MD MI Jeremy Goverman, MD Anthony J. Falvo, DO Ronald I. Gross, MD, FACS Michigan Alok Gupta, MD Majid Aized, MD Patricia Maher Harrison, RN, MSN, Harry L. Anderson III, MD CCRN,ACNP-BC Mandip S. Atwal, DO Peter A. Hartmann, MD, FACS Alfred E. Baylor III, MD Carl J. Hauser, MD William Matthew Bowling, MD, MBA Joaquim M. Havens, MD Mary-Margaret Brandt, MD Peter S. Hedberg, MD Alan Brockhurst, MD Michael P. Hirsh, MD Joseph R. Buck, MD Horacio M. Hojman, MD Craig F. Copeland, M.D. George Kasotakis, MD Scott B. Davidson, MD Edward Kelly, MD James DeCou, MD David King, MD Lawrence N. Diebel, MD Eric Mahoney, MD Heather Dolman, MD Katherine Mandell, MD, MPH Elango Edhayan, MD David P. Mooney, MD Peter Ehrlich, MD, MSc, H BSc Kevin P Moriarty, MD John J. Fath, MD, MPH Stephen R. Odom, MD David A. Forster, DO Vihas Patel, MD, FACS Joel Green, MD Lisa A. Patterson, MD EAST Membership - Geographical
Ward O. Griffen, MD Jerry Stassinopoulos, MD Mark E. Hemmila, MD Christopher P. Steffes, MD Mark Herman, MD Fresca Swaniker, MD, MPH Laszlo Hoesel, MD Kathleen To, MD Greg A. Howells, MD James G. Tyburski, MD Felicia Ivascu, MD Wayne E. VanderKolk, MD Randy J. Janczyk, MD Mario R. Villalba, MD David M. Kam, MD, MS, FACS James Wagner, MD Jeffry L. Kashuk, MD Wendy L. Wahl, MD John P. Kepros, MP, PC Stewart C. Wang, MD, PhD Alicia Kieninger, MD Jill Watras, MD Amy Koestner, BSN, MSN Robert F. Wilson, MD Kurt A. Kralovich, MD Joshua M. Winowiecki, RN, CCRN Brett F Kuhlmann, PA-C Allan D. Lamb, DO, FACOS Minnesota Scott E. Langenburg, MD Melea Anderson, DNP, RN, CNP Stefan W. Leichtle, MD Beth Ballinger, MD, FACS Peter P. Lopez, MD Michael P. Bannon, MD Ali F. Mallat, MD, MS, FACS Kaysie Banton, MD Connie R. Mattice, RNC, MS, ANP, CCRN Bruce A. Bennett, MD, FACS Michael McCann, DO Matthew Byrnes, MD Judy N. Mikhail, RN, MSN, MBA J. Kevin Croston, MD Chet A. Morrison, MD, FACS John K. Cumming, MD Michael Mueller, MD David J. Dries, MD Lena M. Napolitano, MD Brad Feltis, MD, PhD Pauline K. Park, MD Jonathan Gipson, MD Sujal G Patel, MD, FACS Stephanie Heller, MD Joe H. Patton, Jr., MD Donavon Hess, MD, PhD, MBA Douglas G. Paulk, DO David Hirschman, MD, FACEP, FAAP Richard A. Pomerantz, MD Donald H. Jenkins, MD Mary-Anne Purtill, MD Brian D. Kim, MD Carlos Rodriguez, MD, FACS Matthew Kissner, MD, FACS Thomas J. Rohs, Jr., MD Nathaniel Kreykes, MD Gaurav Sachdev, MD Jon C Krook, MD Donald J. Scholten, MD Anne L. Lambert, MD Brian S. Shapiro, MD Mark V. Larkins, MD, MA Robert F. Smith, MD Kurt A. Martinson, MD, FACS EAST Membership - Geographical
Michael D. McGonigal, MD Kareem Husain, MD Christopher Moir, MD Robert Johnson, Jr, MD, MS David S. Morris, MD Martin Keller, MD Steven G. Muehlstedt, MD James W. Kessel, MD Arthur L. Ney, MD John P. Kirby, MD John B. Osborn, M.Sc. Kevin R. Mahoney, MD, FACS Cassandra A. Palmer, MD Joseph S. McCadams, MD D. Donald Potter, MD John J. Moll, MD Mariela Rivera, MD Christopher Nelson, MD Mark D. Sawyer, MD Ann Peick, MD Henry J. Schiller, MD Valerie M. Pruitt, MD, Lt.Col., USAF, MC Julia Senn-Reeves, MSN Charles M. Richart, MD Martin D. Zielinski, MD Scott G. Sagraves, MD, FACS Scott P. Zietlow, MD, FACS Joseph A. Salomone, MD Douglas J.E. Schuerer, MD, FACS Mississippi Floyd E. Scott, Jr., MD, FACS Naveed A. Ahmed, MD Robert Southard, MD William T. Avara III, MD Philip C. Spinella, MD, FCCM Lonnie W. Frei, MD Jane E. Tenquist, MD, FACS Amber L. Kyle, BS, MSN Brian M. Tibbs, MD Larry C. Martin, MD Arthur L. Trask, MD Thomas S. Messer, Jr., MD Dennis W. Vane, MD John Porter, MD Kandra Voshage, PA-C, MPAS Gregory A. Timberlake, MD Sandra Wanek, MD Wesley B. Vanderlan, MD Robert D Winfield, MD Teresa Windham, RN Montana Missouri Chad Engan, MD, FACS Stephen L. Barnes, MD Michael Englehart, MD H. Scott Bjerke, MD Frederick M. Ilgenfritz, MD Grant V. Bochicchio, MD,MPH Stephanie Bonne, MD Nebraska Jeffrey Coughenour, MD Reginald A. Burton, MD Stephen Eaton, MD Randeep S. Jawa, MD Joseph Fugaro, MD Stanley Okosun, MD, MSc, FACS Michael P Heid, DO, MA, FACOS Paul J Schenarts, MD David A. Horwitz, MS Michel Wagner, MD EAST Membership - Geographical
Nevada Dominick J. Eboli, MD, FACS Timothy D. Browder, MD William F. Fallon Jr., MD, MBA Jay E. Coates Jr., DO, FACOS, FACS Adam D Fox, DO, FACS John J. Fildes, MD Nicole Fox, MD, MPH Nichole Ingalls, MD Stephen C. Gale, MD Deborah A. Kuhls, MD Vicente H. Gracias, MD Allan David MacIntyre, DO Raymond H. Green, DO Kiarash Mirkia, MD Jeffrey S. Hammond, MD, MPH Jay Jenoff, MD New Hampshire Sanjeev Kaul, MD Kenneth W. Burchard, MD Anastasia Kunac, MD Rajan Gupta, MD David H. Livingston, MD Sanjay Gupta, MD, MCh John J. LoCurto Jr., MD, FACS Laurie Latchaw, MD Robert V. Madlinger, DO Richard Murphy, MD John T. Malcynski, MD Kurt K. Rhynhart, MD Maurizio A. Miglietta, DO John E. Sutton Jr., MD Alicia M. Mohr, MD New Jersey Paul L O'Donnell, DO Hesham Ahmed, MD J. Martin Perez, MD Devashish J. Anjaria, MD Kyle N. Remick, MD Alex Axelrad, MD, FACS,FCCM Stancie C Rhodes, MD A. Rippey, MD Jaroslaw W. Bilaniuk, MD, FACS Kelly Ravikumar Brahmbhatt, MD Patricia A. Schrader, MD, FACS Sherwin P. Schrag, MD. MSC Thomas A. Buzard, MD Robert W. Schulze, MD FACS Thomas J Cartolano, DO Mitchell Chaar, MD Mark J. Seamon, MD Adam M. Shiroff, MD Akella Chendrasekhar, MD John H. Siegel, MD Brad M. Chernock, PA-C, MS John Chovanes, DO Ziad C. Sifri, MD Sherry L Sixta, MD Louis F. D'Amelio, MD Alan J. Sori, MD Saraswati Dayal, MD Marissa De Freese, MD Perry W. Stafford, MD Meredith S. Tinti, MD Janice K. Delgiorno, RN Stanley Z. Trooskin, MD, FACS William G. DeLong Jr., MD Louis DiFazio, Jr., MD Leslie S Tyrie, MD Jerome J. Vernick, MD Renay E. Durling-Grover, RN, MSN, CEN Todd R. Vogel, MD EAST Membership - Geographical
Melissa H. Warta, MD Michael D. Grossman, MD Jeffrey S. Weisberger, PA-C M. Alex Guerrero, MD, FACS Weidun Alan Guo, MD, PhD New York Daniel Haller, MD Alfred Adamo, MD Katrina Harper, MD Daniel A. Adams, Moustafa A. Hassan, MD, FACS Fahd Ali, MD Lynn J. Hydo, RN, MBA, FCCM Kathy V. Aronow, RN, MSN, BC Kevin M Jones, MD, MPH Bonnie Arquilla, DO Lynn Kemp, RN, MA Juan A. Asensio, MD, FACS Michael J. Kim, MD, MA Matthew Bank, MD Anthony Kopatsis, MD Paul E. Bankey, MD, PhD Eric Legome, MD Philip S. Barie, MD, MBA Gary Lombardo, MD Omar Bholat, MD Joan Madalone, MS Carina Biggs, MD Corrado P. Marini, MD, FACS Jesse A. Blumenthal, MD William H. Marx, DO, FACS Daniel J. Bonville, DO Wayne E. Mashas, MD David C. Borgstrom, MD, FACS Jane E. McCormack, RN, BSN Jeffrey J Brewer, MD John McNelis, MD Lourdes Castanon, MD Kathleen P. O'Hara, MD Julius D. Cheng, MD, MPH Patricia A. O'Neill, MD Michael Chopko, MD Michael Paccione, Robert N. Cooney, MD H. Leon Pachter, MD, FACS, PC Robert Davis, MD Samir Pandya, MD Jonas DeMuro, MD Walter F. Pizzi, MD Patrick A. Dietz, MD John J. Platz, MD Stephen C.M. DiRusso, MD, PhD Soula Priovolos, MD Lisa Dresner, MD H. David Root, MD Albert O. Duncan, MD Nelson G. Rosen, MD Soumitra R. Eachempati, MD David B. Safran, MD Thomas Fabian, MD Ayodele T. Sangosanya, MD Maryann Fields, RN, BSN, CNOR John A. Savino, MD William J. Flynn Jr., MD Gerald W. Shaftan, MD Spiros G. Frangos, MD, MPH Kaushal H. Shah, MD Asaf A. Gave, MD Niral Shah, MD Evan R. Geller, MD Howard M. Simon, MD Mark L. Gestring, MD, FACS Ronald J. Simon, MD EAST Membership - Geographical
Nicole A. Stassen, MD, FACS, FCCM Burton H. Harris, MD, FACS, FAAP Melvin E. Stone Jr, MD Amy Hildreth, MD Steven Stylianos, MD James H. Holmes IV, MD Susan M. Talbert, MD Toan T. Huynh, MD, FACS, FCCM S. Rob Todd, MD, FACS David G. Jacobs, MD Jose D. Torres, MD Daryhl L. Johnson, II, MD, MPH Fausto Vinces, DO FACOS R. Shayn Martin, MD James A. Vosswinkel, MD J. Wayne Meredith, MD, FACS Warren D. Widmann, MD Anthony A. Meyer, MD, PhD, FACS Charles E. Wiles III, MD, FACS,FCCM William S. Miles, MD Chad T Wilson, MD, MPH Preston R. Miller III, MD Jay A. Yelon, DO Sean P. Montgomery, MD Roger W. Yurt, MD Nathan T. Mowery, MD Mark A. Newell, MD North Carolina James V. O'Connor, MD Jeffrey E. Abrams, MD Dale W. Oller, MD Sasha D Adams, MD Timothy N. Patselas, MD Amy Rezak Alger, MD, FACS John Petty, MD Abenamar Arrillaga, MD Preston B. Rich, MD Michael R. Bard, MD Michael F. Rotondo, MD, FACS Sukanto Biswas, MD, FACS Edmund J. Rutherford, MD Matthew D Bitner, MD Mark L. Shapiro, MD C. Michael Buechler, MD William R.C. Shillinglaw, DO Faera L. Byerly, MD Ronald F. Sing, DO Bruce A. Cairns, MD David J Skarupa, MD Michael C. Chang, MD Michael H. Thomason, MD A. Britton Christmas, MD, FACS Errington C. Thompson, MD Thomas V. Clancy, MD Eric A. Toschlog, MD, FACS Anne M. Conquest, MD Pascal O. Udekwu, MD Paul R.G. Cunningham, MD Steven N. Vaslef, MD, PhD Susan L. Evans, MD, FACS Brett Harden Waibel, MD Peter E. Fischer, MD, MS James O. Wyatt III, MD Stephen F. Flaherty, MD Mary O. Aaland, MD, FACS Michael Gibbs, MD Steven E. Briggs, MD Claudia E. Goettler, MD Derek Kane, MD, MS John M. Green, MD Fady Nasrallah, MD Carl E. Haisch, MD Michael Schmit, MD, FACS EAST Membership - Geographical
Ohio Brian D. Kenney, MP, MPH Mohammed Y. Ahmed, MD F. Barry Knotts, MD, PhD Brandice Alexander, DO David E. Lindsey, MD Krishna Athota, MD Michele M. Loor, MD Hiba Abdel Aziz, MD Deborah Matosky, MS, APRN, FNP John Alexander Bach, MD Robert J. Maxwell, MD Paul R. Beery, II, MD Mary C. McCarthy, MD Daniel I. Borison, MD Amy A. McDonald, MD Anthony P. Borzotta, MD Sidney F. Miller, MD Rebeccah L. Brown, MD, FACS Matthew L. Moorman, MD, FACS, FCCP John D. Brownlee, MD, FACS R. Lawrence Moss, MD Stuart J.D. Chow, DO Farid F. Muakkassa, MD Rapheal Chung, MD Dilip B. Narichania, MD Jeffrey A. Claridge, MD, MS Michael F. Oswanski, MD John J. Como, MD, MPH Charu Paranjape, MD Charles H. Cook, MD Nimitt J. Patel, MD Marcus F. Cox, MD Douglas B. Paul, DO, FACOS Kenneth Davis Jr., MD Steven C. Pearse, MD, FACS Victor V. Dizon, DO, FACOS Attila Poka, MD Heath A. Dorion, MD Phillip D. Price, MD Warren C. Dorlac, MD Timothy A. Pritts, MD, PhD C. Michael Dunham, MD, FACS Bryce R.H. Robinson, MD Akpofure Peter Ekeh, MD Michael A. Samotowka, MD, FACS Richard A. Falcone, Jr., MD, MPH Steven A. Santanello, DO Eric Ferguson, MD, PhD Jonathan M. Saxe, MD Joyce V. Frame, Steven S. Schumacher, MD, FACS Richard B. Fratianne, MD Jonathan E. Schweid, MD Victor F. Garcia, MD Howard L. Shackelford Jr., MD Richard L. George, MD, MSPH Om P. Sharma, MD Jonathan I. Groner, MD Michael Sheehan, MD Brian S Gruber, MD James M. Sinard, MD Jennifer L. Hartwell, MD Anthony Stallion, MD Kimberly Hendershot, MD, FACS Kirby Sweitzer, MD Jay A. Johannigman, MD Joseph A. Talarico, MD Larry M. Jones, MD Kathryn M. Tchorz, MD, FACS Jason C. Keith, MD Betty J. Tsuei, MD Steven M. Kelly, MD,FACS Jeffrey L. Turner, MD EAST Membership - Geographical
Mbaga S. Walusimbi, MD Steven Allen, MD Melissa L Whitmill, MD Daniel T. Altman, MD Mallory Williams, MD, MPH Scott B. Armen, MD Randy J. Woods, MD Jehangir Badar, MD, FACS Salina M. Wydo, MD Michael M. Badellino, MD Susan Yeager, MS, RN, ACNP Robert Barraco, MD, MPH Charles J. Yowler, MD Roger R. Barrette, MD Adam Zochowksi, MD, FACS Graciela Bauza, MD Gregory K. Beard, DO Oklahoma Jeffrey J. Bednarski, MD Carl T. Bergren, MD Ronnie S. Benoit, MD, FACS C. Anthony Howard, MD Jack M. Bergstein, MD, FACS Jason S. Lees, MD Joel E. Borkow, MD Robert W. Letton Jr., MD Benjamin M. Braslow, MD Nathan Powell, DO Robert A. Brigham, MD Edwin Yeary, MD Joshua B. Brown, MD Oregon Darren Bryant, MD Ronald Barbosa, MD M. Hassan Budeir, MD Frederic J. Cole Jr., MD Richard K. Burns, MD Vernon L. Cowell , Jr., MD, MPH Riad Cachecho, MD, MBA Stephanie Gordy, MD Jeannette M. Capella, MD, Med Carney, MD Erica Loomis, MD Daniel E. John C. Mayberry, MD Brendan G. Carr, MD, MA, MS Justin D. Chandler, MD Andrew J. Michaels, MD, MPH James Cipolla, MD Lori J. Morgan, MD Ameen I. Ramzy, MD, MBA, FACS Keith D. Clancy, MD John R. Clarke, MD Susan E. Rowell, MD Murray J. Cohen, MD Martin A. Schreiber, MD, FACS Scott P. Sherry, MS, PA-C Alain C. Corcos, MD Terrence Curran, MD Bert M. Stewart, MD Dale Dangleben, MD Donald D. Trunkey, MD, FACS Jennifer M. Watters, MD, FACS Jay E. Dujon, MD Russell Dumire, MD Pennsylvania James S. Eakins, MD Nikhilesh N. Agarwal, MD, FACS Brett W. Engbrecht, MD, MPH Louis H. Alarcon, MD Forrest Fernandez, MD Mary Kate FitzPatrick, RN, MSN EAST Membership - Geographical
Raquel M. Forsythe, MD DiAnne J. Leonard, MD Shannon M. Foster, MD Jeffrey H. Levine, MD, FACS, MMM Barbara A. Gaines, MD Mark J. LiBassi, MD, FACS Luis J Garcia, MD Jayme David Lieberman, MD, FACS Juliet A. Geiger, RN, MSN Gary A. Lindenbaum, MD, FACS, FCCP John Gillard, PA John J. Lukaszczyk, MD, FACS Amy J. Goldberg, MD James M. Lynch, MD Kimberly Green, CRNP Mark A. Malangoni, MD Sarah Greer, MD, MPH William J. Mannella, MD James S. Gregory, MD Joshua A. Marks, MD Wassim G. Habre, MD Gary T. Marshall, MD Geoffrey G. Hallock, MD Niels D. Martin, MD William D. Hardin, Jr., MD Kazuhide Matsushima, MD Joshua P. Hazelton, DO Maureen McCunn, MD, MIPP, FCCM Catherine R. Herman, MD Christine J. McKenna, MSN Brian A. Hoey, MD Amanda McNicholas, RN, MSN, CRNP William S. Hoff, MD S. Lee Miller, MD, FACS Daniel N Holena, MD Forrest C. Mischler, MD, FACS John J. Hong, MD Matthew L. Moront, MD K. Michael Hughes, DO Richard Nahouraii, MD Matthew C. Indeck, MD Michael P. Najarian, MD Marcin A. Jankowski, DO Michael L. Nance, MD Elan Jeremitsky, MD Adrian W. Ong, MD Steven A. Johnson, MD Meade T. Palmer, MD, FACS Robert A. Jubelirer, MD Jose L. Pascual Lopez, MD, PhD, FRCS(c) David Kashmer, MD, MBA, MBB Michael D. Pasquale, MD, FACS, FCCM Kris R. Kaulback, MD Pankaj H. Patel, MD, FACS Scott Keeney, DO Abhijit S. Pathak, MD, MSE Michael E Kelly, DO Andrew B. Peitzman, MD Robert W. Kelly, MD, FACS Allan S. Philp, MD Patrick K. Kim, MD Marc E. Portner, MD John D. Kizer, MD Juan Carlos Puyana, MD Brian E. Klock, MD, FACS Max L. Ramenofsky, MD George Koenig, DO, MS Eugene F. Reilly, MD Amy E Krichten, RN, BSN, CEN Patrick M. Reilly, MD Simon D. Lampard, MD Benjamin R. Reynolds, MS John C. Lee, MD Aurelio Rodriguez, MD EAST Membership - Geographical
Frederick Rogers, MD Kenneth Widom, MD Matthew R. Rosengart, MD, MPH, FACS James (Jack) E. Wilberger Jr., MD Rovinder S. Sandhu, MD Laurie N. Wilson, PA-C Thomas A. Santora, MD Charles C. Wolferth, MD Jack Sariego, MD Philip C. Wry, MD David W. Scaff, DO Daniel Wu, DO Vaishali Schuchert, MD James V. Yuschak, MD C. William Schwab, MD Jenny Ziembicki, MD Ronald J. Scorpio, MD, FACS, FAAP Elizabeth B. Seislove, RN, MSN, CCRN Puerto Rico Kamalesh T. Shah, MD, FACS Pablo R. Ortiz, MD, FACS, FCCM Khaleel A. Shaikh, MD Mariluz Rivera-Hernandez, MD Corinna Sicoutris, MSN, CRNP, FCCM Rhode Island Mohammad S. Siddiqui, MD, MBA, FRCS, Charles A. Adams Jr., MD FACS Jeremy T Aidlen, MD Carrie A. Sims, MD Michael Connolly, MD Lars Ola Sjoholm, MD Shea C. Gregg, MD Robert W. Solit, MD David T. Harrington, MD, FACS Jason L. Sperry, MD, MPH George A. Perdrizet, MD Jessica Summers, MD Raymond C. Talucci, MD South Carolina John M. Templeton Jr., MD Sherwood W. Barefoot Jr., MD Shawn M. Terry, MD, FACS Raymond P. Bynoe, MD Peter Thomas, DO Debbie J. Couillard, RN Shelly D. Timmons, MD, PhD Bruce A. Crookes, MD, FACS Samuel A. Tisherman, MD Evert Eriksson, MD Christine C. Toevs, MD Samir M. Fakhry, MD, FACS Bartholomew J. Tortella, MTS, MD, MBA, Stephen A Fann, MD FACS. FCCM Michael W.L. Gauderer, MD Frederick Toy, MD Stuart M. Leon, MD Eric S. Treaster, MS Kristine A.K. Lombardozzi, MD, FACS Anthony O. Udekwu, MD Benjamin M. Manning, MD Sydney J. Vail, MD, FACS, FABC Stephanie Montgomery, MD Carl P. Valenziano, MD, MPA, FACS Charles E. Morrow Jr., MD Marla L. Vanore, RN, MHA Bryan C. Morse, MS, MD Michael S. Weinstein, MD E. Douglas Norcross, MD Gary W. Welch, DO, FACOS EAST Membership - Geographical
Mark A. Reynolds, MD Robert A. Maxwell, MD Joseph V Sakran, MD, MPH Addison K. May, MD Christian J. Streck, Jr., MD Vicente A. Mejia, MD Richard S. Miller, MD South Dakota Gayle Minard, MD Dennis Glatt, MD John A. Morris Jr., MD Justin L. Green, MD, PhD, MBA, FACS Stephen Morrow, MD Christopher M. Larson, MD Nancy A. Moulton, PA-C Michael Person, MD Todd Nickloes, DO Dustin Smoot, MD Timothy C. Nunez, MD Gary L. Timmerman, MD, FACS Mickey Ott, MD Tennessee Mayur B. Patel, MD, MPH, FACS Raeanna Adams, MD A. Tyler Putnam, MD, FACS Daniel Anderson, MD David B. Reath, MD Donald E. Barker, MD Thomas J. Schroeppel, MD Tiffany K. Bee, MD Lou M. Smith, MD Mary Kathryn Boggs, DO Philip W. Smith, MD Beth A. Broering, MSN Scott T. Smith, MD I. William Browder, MD Joseph Swanson, Pharm.D. Alicia Burt, PA Dana A. Taylor, MD George M. Testerman, MD Neeta Chaudhary, MD, PhD George (Neal) O. Vinsant, MD Martin A. Croce, MD Brian J. Daley, MD, MBA Jordan A. Weinberg, MD Ben L. Zarzaur, MD, MPH Benjamin W. Dart IV, MD Bradley Dennis, MD Texas Lemuel L. Dent, MD Rondel Albarado, MD Blaine L. Enderson, MD, MBA Darrell E. R. Alley, MD, FACS James Eubanks, III, MD Jayson Aydelotte, MD Timothy C. Fabian, MD Luis Alfonso Benavente Chenhalls, MD Oscar D. Guillamondegui, MD John D. Berne, MD Oliver L. Gunter, Jr., MD, FACS Lorne H. Blackbourne, MD, FACS Jeffrey S. Guy, MD Osbert Blow, MD, PhD John R. Hall, MD Aaron S. Bransky, MS, MD Christy M. Lawson, MD Leopoldo C. Cancio, MD Louis J. Magnotti, MD Jeremy Cannon, MD, SM George O. Maish III, MD Matthew M. Carrick, MD EAST Membership - Geographical
James Patrick Carroll, MD Basil A. Pruitt, Jr., MD Stephen Cohn, MD Leslie D. Reddell, DO Alan D Cook, MD Evan M. Renz, MD, FACS Thomas B. Coopwood, Jr., MD Jose Ruben Rodriguez, MD, MMSC Bryan A. Cotton, MD, MPH Emily A. Rogers, MD James M. Cross, MD Stephen Rowe, MD Craig Owen Daniel, MD Bradford Scott, MD Matthew Davis, MD Shahid Shafi, MD, MPH Dennis B. Dove, MD Matthew J. Sideman, MD James H. Duke Jr., MD Phillip Sladek, MD Alexander Eastman, MD David C. Smith, MD Brian J. Eastridge, MD Randall W. Smith, MD, FACS Thomas A. Erchinger, MD Mark Tellez, MD Luis G. Fernandez, MD Erwin Thal, MD Geoffrey A Funk, MD, FACS George H Tyson, III, MD Dan Galvan, MD Todd J. Waltrip, MD Rajesh R. Gandhi, MD, PhD, FACS, FCCM David E. Wesson, MD Neil A. Grieshop, MD, FACS, CHCQM Christopher E. White, MD, FACS Kirby R. Gross, MD Brian H. Williams, MD, FACS Shaikh A. Hai, MD, FACS Steven E. Wolf, MD John B. Holcomb, MD Cynthia Lauer, MD Utah Lillian Liao, MD, MPH Alexander L. Colonna, MD Manuel Lorenzo, MD Toby M. Enniss, MD Joseph D Love, DO David P.J. Garry, MD Stephen S.Y. Luk, MD, FACS, FCCP Sheila G. Garvey, MD, FACS Jonathan B. Lundy, MD Mark H. Stevens, MD, FACS Kenneth L. Mattox, MD Daniel J. Vargo, MD Thomas M. McGovern, MD Vermont Joseph P. Minei, MD, FACS William E. Charash, MD, PhD Christian T. Minshall, MD, PhD Deborah Cole, BS, MS Laura J. Moore, MD John H. Davis, MD Michael A. Norman, MD John B. Fortune, MD Clinton Pace, MD Kennith H. Sartorelli, MD David E. Parkus, MD Paul A. Taheri, MD, MBA Laura Petrey, MD Margaret A. Tandoh, MD Herb A. Phelan III, MD, FACS EAST Membership - Geographical
Virginia Washington Michel Aboutanos, MD, MPH Saman Arbabi, MD, MPH Rahul Anand, MD Teresa D. Bell, MD Khaled Basiouny, MD Scott C Brakenridge, MD, MSCS Tracy R. Bilski, MD, FACS Elizabeth K. Crawford, MS, PA-C Eric H. Bradburn, DO MS FACS George R. Dulabon, MD L. D. Britt, MD Matthew J. Martin, MD James Forrest Calland, MD Aml M. Raafat, MD Bryan R. Collier, DO FACS MaryClare Sarff, MD Jay N. Collins, MD Therese M. Duane, MD, FACS West Virginia Angela S. Earley, MD Aaron Brown, MD John R. Edwards, MD Philip F. Caushaj, MD, PhD Paula Ferrada, MD Robert L. Cross, MD John J. Ferrara, MD, MS David A. Denning, MD Stephanie R. Goldberg, MD David Ghaphery, MD Margaret M. Griffen, MD Fawad J. Khan, MD Mark E. Hamill, MD Jennifer Christine Knight, MD Jeffrey H Haynes, MD Frank C. Lucente, MD, FACS Rao R. Ivatury, MD William R. Peery, II, MD Donald R. Kauder, MD Gregory P. Schaefer, DO, FACS Ajai K. Malhotra, MD Amy Tortorich, DO Julie A. Mayglothling, MD Alison M. Wilson, MD Christopher P. Michetti, MD Rebecca Wolfer, MD Timothy J. Novosel, MD Wisconsin Travis M. Polk, MD Suresh K. Agarwal, Jr., MD Ranjit R. Pullarkat, MD Marshall Beckman, MD Scott F. Reed, MD Annette Bertelson, BSN Hani M. Seoudi, MD Jeffrey A. Blink, MD, FACS Richard P. Sharpe, MD David L. Ciresi, MD, FACS Gregory G. Stanford, MD Daniel C. Cullinane, MD Zsolt T. Stockinger, MD Vicki Dembowiak, RN Leonard J. Weireter Jr., MD Michael J. Foley, MD Jeffrey S. Young, MD David Gourlay, MD Jamshed A. Zuberi, MD Cheryl A. Grandlich, MSN, ACNP Gaby A.P. Iskander, MD EAST Membership - Geographical
Jeremy S. Juern, MD Patrick Kiefer, MD Kenneth A. Kudsk, MD Ivan Maldonado, MD David J Milia, MD Todd A. Neideen, MD Samuel B. Picone Jr., MD Lewis B. Somberg, MD, FACS Alex D. Wade, MD Robb R. Whinney, DO east foundation
BOARD OF TRUSTEES 2012
Executive Committee
President (2015) Treasurer (2014) Fred A. Luchette, MD, FACS, FCCM Kimberly K. Nagy, MD, FACS
Vice President (2013) Secretary (2014) Patrick M. Reilly, MD, FACS Donald H. Jenkins, MD, FACS
Board of Trustees
Robert Barraco, MD, MPH (2015) Vicente H. Gracias, MD (2015) Erik S. Barquist, MD, FACS (2015) Lawrence Lottenberg, MD (2013) Andrew C. Bernard, MD, FACS (2015) Patricia O’Neill, MD (2013) Mary Kate FitzPatrick, RN, MSN, CRNP (2013) James G. Tyburski, MD, FACS (2013) Mark L. Gestring, MD, FACS (2013) Jay A. Yelon, DO (2015)
Ex Officio Members
EAST President (2013) Jeffrey P. Salomone, MD, NREMT-P
EAST Secretary/Treasurer (2013) Kimberly A. Davis, MD, FACS, FCCM
EAST Scholarship Chair (2014) Shahid Shafi, MD, MPH
Past Presidents
Samir M. Fakhry, MD, FACS 2009-2012
Philip S. Barie, MD, MBA 2007-2009
Eric R. Frykberg, MD 2004-2006
David B. Reath, MD 2002-2003
EAST Foundation Development Committee Co-Chairs Andrew C. Bernard, MD Vicente H. Gracias, MD
Honorary Chairs Drs. Jack & Pina Templeton
Members Suresh K. Agarwal, Jr., MD Stephen L. Barnes, MD Mark D. Cipolle, MD, PhD Bryan A. Cotton, MD David Kashmer, MD, MBA, MBB Sidney F. Miller, MD Babak Sarani, MD
Ex-Officio Fred A. Luchette, MD, FACS, FCCM
2012 Campaign for EAST Donor Honor Roll
We gratefully acknowledge our Member Contributors for their generous support.
Member Partners, January 1 – December 4, 2012
* Leadership Circle members who have contributed $1,000 or more ** Elite Circle members who have contributed $2,000 or more
Sandra Arabian Joseph DuBose Scott Armen Juan Duchesne Linda Atteberry * Kevin Dwyer Michael Bard Christine Eme Stephen Barnes * Blaine Enderson * Erik Barquist * Evert Eriksson Robert Barraco Thomas Esposito Jeffrey Bednarski Timothy Fabian Andrew Bernard * Samir & Cynthia Fakhry ** Annette Bertelson Mary Fallat William Bowling Richard Fantus Mary-Margaret Brandt John Fath Steven Briggs Eric Ferguson Rebeccah Brown Forrest Fernandez Joshua Brown Mary Kate FitzPatrick Jeremy Cannon Stephen Flaherty Jeannette Capella Henri Ford Howard Champion * Raquel Forsythe William Chiu Adam Fox Ashley Christmas Joyce Frame Mark Cipolle * Eric Frykberg * Keith Clancy George Garcia Jeffrey Claridge Juliet Geiger John Como Mark Gestring * Ben & Robin Coopwood * Amy Joy Goldberg Bruce Crookes Vicente Gracias Paul Cunningham John Green Brian Daley Wendy Greene Kimberly Davis * Ronald Gross James DeCou Weidun Alan Guo Rafael Diaz-Flores Rajan Gupta Andrew Doben Cary Hanni Heather Dolman Burton Harris ** Warren Dorlac Robbi Hartsock Elliott Haut A. Tyler Putnam Michael Heid Jin Ra * Kimberly Hendershot Tarek Razek Sharon Henry * David Reath William Hoff Carol Reese Matthew Indeck Patrick Reilly * Lenworth Jacobs * Peter Rhee Randeep Jawa Michael Rhodes * Donald Jenkins * Thomas Rohs Kimberly Joseph Michael Rotondo ** Stephen Kaminski Susan Rowell Gary Kaml Grace Rozycki & David Feliciano Andrew Kerwin * Scott Sagraves Brett Kuhlmann Jeffrey Salomone * Deborah Kuhls Heena Santry Stanley Kurek Thomas Scalea ** Amber Kyle * Henry Schiller Karen Lommel Martin Schreiber Peter Lopez Douglas Schuerer Larry Lottenberg * Carl Schulman Fred Luchette ** Kevin Schuster George Maish, III Mark Seamon Debra Malone Shahid Shafi Joshua Marks Mark Shapiro William Marshall Adam Shiroff Niels Martin Jason Smith * Kimball Maull Lou Smith Julie Mayglothling Nicole Stassen Amy McDonald Kathryn Tchorz Norman McSwain * Jack & Pina Templeton ** Christopher Michetti Peter Thomas Judy Mikhail Gregory Timberlake Joseph Minei Eric Toschlog Christian Minshall James Tyburski * Matthew Moront Carl Valenziano Kimberly Nagy Steven Vaslef Michael Nance W. Matthew Vassy Donna Nayduch Alison Wilson Arthur Ney Randy Woods Terence O'Keeffe Jay Yelon Patricia O'Neill * Pamela Young Neil Parry James Yuschak * Michael Pasquale * Tanya Zakrison Dustin Petersen Ben Zarzaur Herbert Phelan III Martin Zielinski
Historic Campaign Member Commitment: Drs. Jack and Pina Templeton
2012 Annual Dodgeball Tournament Contributors: Jeremy Cannon William Chiu Patrick Kim Larry Lottenberg Karen Lommel Martin Schreiber Douglas Schuerer Jason Sperry Martin Zielinski
2012 Raffle Prize Contributors: Eastern Association for the Surgery of Trauma Samir & Cynthia Fakhry Fred Luchette Kimberly Nagy Peter Rhee UBS Financial Services Carl Valenziano
Pioneer Donor: The Dorothy K. Commanday Foundation and Edward Yelon
2012 Campaign Corporate Partners
We gratefully acknowledge our Corporate Partners for their generous support.
Leadership Level $200,000+
Leadership Level $100,000+
Platinum Level $75,000+
Silver Level $25,000+
Bronze Level $10,000+
Campaign Contributors $2,500 +
Dear Colleagues,
The EAST Foundation is committed to supporting the Eastern Association for the Surgery of Trauma (EAST) and its members in achieving their goals as young Trauma Surgeons. Working closely with the EAST leadership and its members, the Foundation seeks to achieve a number of objectives that support the mission of EAST. These include promoting research and education to achieve advances in the care of the injured patient and in injury control and prevention; enhancing the professional growth and development of established trauma surgeons as well as prospective trauma surgeons; and promoting quality educational programs for trauma surgeons and trauma providers.
The EAST Foundation achieves its goals through the generosity of individuals, groups, and organizations who have made a commitment to advancing the field of Trauma. Currently, the Foundation supports the utstanding following o activities:
‣ Scott B. Frame, MD Memorial Lecture ‣ Raymond H. Alexander, MD Resident Paper Competition,Travel scholarships supported by Synthes through an unrestricted grant ‣ Cox-‐Templeton Injury Prevention Paper Competition ‣ John M. Templeton, Jr., MD Injury Prevention Research Scholarship ‣ EAST Foundation Trauma Research Scholarship, Supported by KCI and LifeCell through an unrestricted grant ‣ Travel Scholarships for Oriens Award Fellows to EAST Annual Scientific Assembly,Supported by Z-‐Medica through an unrestricted grant ‣ EAST Education Center,Supported by Edwards Lifesciences through an unrestricted grant ‣ EAST Leadership Development Workshop, Supported by Z-‐Medica through an unrestricted grant ‣ Brandeis University Leadership Conferencein Health Policy and Management, Funding for this scholarship has been made possible by a generous donation from the Dorothy K. Commanday Foundation and Edward Yelon ‣ Society of Trauma Nurses-‐EAST Foundation Nurse Fellow Program, Supported by Ethicon through an unrestricted grant ‣ EAST Community Outreach Program ‣ EAST Practice Management GuidelinesSupplement – Published November 2012,Journal of Trauma and Acute Care Surgery ‣ Rib Fracture Study,S upported by Synthes through a research grant ‣ EAST FoundationLaser Tag TeamCompetition during the 2013 EAST Annual Scientific Assembly,Supported by Emergency Surgical Staffing through an unrestricted grant
The Foundation successfully led the Campaign for EAST to an historic level of over $1,000,000 in donations and multi-‐year pledges. The money raised will help EAST achieve its goals in improving trauma care and supporting young trauma surgeons and trauma healthcare providers. This is an exciting time in EAST’s history and, on behalf of the leadership, the Foundation looks forward to working with all of you to continue our fundraising efforts and achieve the goals of EASTin improving trauma care.
The Board of Trustees of the EAST Foundation is available to you for any questions or suggestions you may have and is grateful for your generosity.
Sincerely,
Fred A. Luchette President, EAST Foundation